Infectious and Non-infectious Causes of Fever

Created on Mon, 07/13/2015 - 19:24
Last updated on Sun, 10/04/2015 - 09:18

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Paul Marik had published an excellent article on this topic in 2000, which to this day remains a definitive resource for the person trying to generate a broad range of differentials. The need to generate such a range has come up several times in the CICM written papers, notably in  Question 9 from the second paper of 2009 and in Question 1 from the second paper of 2002.

Given the broad range of things that can get infected (or non-infectiously inflamed) one can hardly call any list a "definitive" list. However, somewhere in one's cognitive arsenal one ought to have a table which looks like this, covering the major categories.

Differential Diagnosis of Fever in the ICU Patient

Infectious causes (i.e. sources)

Noninfectious causes

  • Airway
    • Pharyngitis
    • Sinusitis (eg. NG-tube associated)
    • Dental infection
  • Respiratory system
    • Pneumonia, bronchitis
    • VAP
  • Circulatory system
    • CVC-associated bloodstream infections
    • Endocarditis, pericarditis, myocarditis
    • Vascular graft infection
    • Infected peripheral cannula
    • Aortitis
    • Mediastinitis
  • Central nervous system
    • Meningitis
    • Encephalitis
    • Epidural abscess
  • Endocrine system
    • Prostatitis
  • Renal/urinary tract
    • Nephritis / pyelonephritis
    • Infected ureteric calculus
    • Cystitis
    • UTI due to IDC
  • Gastrointestinal tract
    • Oeseophagitis
    • Pancreatitis
    • Bowel perforation, ischaemia etc
    • Diverticulitis
    • Perianal or psoas abscess
    • C.difficile colitis
  • Haematological causes
    • Malaria
  • Integument (bones, ligaments, soft tissues)
    • Osteomyelitis, discitis
    • Necrotising fasciitis
    • Cellulitis
  • Vascular
    • Cerebral infarction/hemorrhage
    • Myocardial infarction
    • Ischemic bowel
    • Subarachnoid hemorrhage
    • Fat emboli
    • Deep venous thrombosis/PE
    • Phlebitis/thrombophlebitis
  • Neoplastic
    • Lymphoma-associated fever
    • Renal cell carcinoma
    • Tumour lysis syndrome
  • Drug-induced
    • Alcohol/drug withdrawal
    • Drug fever
  • Idiopathic inflammatory
    • Postoperative fever (48 h postoperative)
    • Acalculous cholecystitis
    • Pancreatitis
    • Aspiration pneumonitis
    • ARDS
    • Gout/pseudogout
    • IV contrast reaction
    • GI bleed
  • Autoimmune
    • Posttransfusion fever
    • Transplant rejection
    • Vasculitis
    • Haemolytic anaemia
  • Traumatic/environmental
    • Haematoma degradation
    • Decubitus ulcers
    • Heat stroke
  • Endocrine
    • Adrenal insufficiency
    • Thyrotoxicosis
    • Thyroiditis (Hashimoto)
    • Ovulation

 

References

Bota, Daliana Peres, et al. "Body temperature alterations in the critically ill."Intensive care medicine 30.5 (2004): 811-816.

Marik, Paul E. "Fever in the ICU." Chest Journal 117.3 (2000): 855-869.

Efstathiou, Stamatis P., et al. "Fever of unknown origin: discrimination between infectious and non-infectious causes." European journal of internal medicine21.2 (2010): 137-143.