The chapter describes a case of a 45-year-old female with type I diabetes who presented with severe diffuse abdominal pain for a day, fevers on and off since yesterday, and persistent nausea with vomiting. The physical exam revealed a mildly distended, diffusely tender abdomen, decreased bowel sounds, and rebound and guarding. The patient was diagnosed with diabetic ketoacidosis and urinary tract infection and was treated with IV fluid bolus, insulin drip, antibiotics, and ICU admission. The chapter provides pearls on the diagnosis and management of abdominal pain, including the importance of early blood glucose assessment, fluid replacement, insulin drip, and ICU admission for DKA, and early antibiotics, fluids, and surgical consultation for peritoneal signs.

This case describes a child with measles, a highly contagious infection caused by a paramyxovirus. This infection is classically characterized by fever, cough, coryza, conjunctivitis, and a characteristic rash that progresses craniocaudally. This case will review the clinical presentation, as well as testing and further management of this illness. We will also discuss the management of measles exposures.

This is an emergency medicine oral board-style case of a transplant patient with a fever. A patient with a history of a renal transplant presents to the emergency department with fever and is found to have sepsis secondary to cellulitis. As transplant patients are immunosuppressed and susceptible to septic shock, successful completion of the case requires the administration of IV fluid bolus, broad-spectrum antibiotics, obtaining blood and urine cultures, consulting the transplant specialist, and appropriately admitting the patient to the ICU.

A retropharyngeal abscess is a serious infection of the soft tissue behind the pharynx, which can in severe circumstances lead to airway obstruction or sepsis. They typically occur in children ages 2−4 years old and are associated with symptoms such as drooling, fever, sore throat, trismus, and neck stiffness with extension. Early interventions include airway evaluation, IV access, broad-spectrum antibiotics, and ENT consultation. Plain films can be suggestive of a retropharyngeal abscess, but a CT of the neck is often needed for diagnosis. Retropharyngeal abscesses often need surgical drainage, especially if they do not respond promptly to antibiotics.

This chapter presents a case of an 89-year-old female with fever and altered mental status. The patient presents with systemic inflammatory response syndrome (SIRS) due to pneumonia. The case presents the medical interventions to mitigate progression to multiorgan dysfunction or septic shock.

Generalized seizures that occur in children between 6 months and 5 years of age during a febrile illness and last less than 15 minutes are known as simple febrile seizures. Children may experience a brief post-ictal period but should return to baseline fairly quickly. Children with simple febrile seizures should be given antipyretics and a careful history and physical should be performed. If a source of the fever is identified, it should be treated. Most often, children do not require blood work or a lumbar puncture in the work-up of a simple febrile seizure. If the child has returned to baseline and is well-appearing, they may be discharged home with follow-up with their primary care physician. Complex febrile seizures, in contrast, may last longer than 15 minutes, may occur several times in a short period of time, or may be focal. A more thorough work-up is often required for complex febrile seizures.

A 35-year-old male with HIV presents with fever, fatigue, malaise, and a painful red rash that has spread to his abdomen and arms. He also has ulcers in his mouth and burning with urination. The primary survey reveals no respiratory distress, no cyanosis, and good peripheral pulses. The secondary survey shows purpuric macules and plaques over the neck and chest, vesicles and bullae over the extensor surfaces of the arms, and small oral erosions to bilateral buccal mucosa. The diagnosis is Stevens–Johnson syndrome, likely triggered by the patient’s recent use of a sulfur-containing antibiotic for his abscess. Critical actions include making the diagnosis based on history and physical examination, stopping the offending agent, fluid administration, dermatology consultation, and ICU or burn unit admission. Medications are the most common trigger of Stevens–Johnson syndrome, and HIV patients taking sulfamethoxazole and trimethoprim are at greater risk. Ocular involvement is common, and recurrence may occur with repeat exposure to the etiologic agent.

Sepsis in infants can present in a variety of ways, including but not limited to fever, lethargy, altered mental status, respiratory distress and poor feeding. An ill-appearing infant should be considered septic until proven otherwise, by obtaining blood, urine, and cerebrospinal fluid samples to be sent for analysis. Broad-spectrum antibiotics should be provided early, and IV fluids should be given, especially if there is concern for septic shock. Infants with sepsis should be admitted to the hospital for monitoring and continued management.

The chapter describes the case of a 45-year-old male with stage 3 HIV who presents to the ED with fever, shortness of breath, pleuritic chest pain, and nonbloody diarrhea. The patient exhibits tachycardia, hypoxia, and a warm, diaphoretic appearance. Initial actions include oxygen supplementation, IV fluids, and labs. The patient is diagnosed with HIV pneumonia, likely Pneumocystis jirovecipneumonia (PCP), and is treated with antibiotics and steroids. Early recognition of fever and hypoxia, along with respiratory isolation, is critical to prevent sepsis. Tests ordered should include CBC, electrolytes, liver function tests, urinalysis and culture, blood cultures, and CXR. Focal infiltrates suggest bacterial pneumonia, while a diffuse interstitial or perihilar, granular pattern on CXR is associated with PCP. Steroids should be given to patients with a partial pressure of arterial oxygen <70 mmHg or an alveolar–arterial gradient of >35 mmHg.

Pediatric patient with sickle cell anemia presenting with fever and rash, with associated URI symptoms found to have aplastic anemia secondary to presumed parvovirus B19 infection. The patient requires emergent blood transfusion and broad-spectrum antibiotics for right-sided pneumonia on chest x-ray. The patient is ultimately admitted to the hospital with a pediatric hematology consultation.

This chapter describes a case of a 45-year-old male with stage 3 HIV who presented to the ED with fever, shortness of breath, pleuritic chest pain, and nonbloody diarrhea. The patient was diagnosed with HIV pneumonia, likely Pneumocystis jiroveci pneumonia(PCP), and was treated with antibiotics, steroids, oxygen supplementation, and IV fluids. The chapter emphasizes the importance of recognizing the symptoms of pneumonia in HIV patients and providing early treatment to prevent sepsis. The chapter also provides guidelines for diagnostic tests and highlights the significance of CD4 counts in the development of pulmonary disorders in HIV patients.

In this chapter, a 56-year-old male with a history of diabetes, hypertension, hyperlipidemia, and alcoholism presents with altered mental status, tachycardia, tachypnea, and fever. Physical exam demonstrates induration of the skin of his perineum with palpable crepitus. Learners are expected to elicit important exam findings and verbalize an appropriate management plan for a patient with Fournier’s gangrene, a necrotizing soft tissue infection of the groin.

After a tsunami, refugees are at risk of numerous causes of morbidity and mortality. Endemic diseases, such as malaria, are among the most common. This case forces participants to consider and diagnose endemic diseases in the setting of a disaster, including determining appropriate workup, both for the end diagnosis and to rule out alternatives, as well as the correct treatment of endemic disease.

A 35-year-old gravida 4 para 3 presents with a fever and diarrhea in the setting of exposure to raw and unpasteurized foods. Symptoms are consistent with listeriosis and a local outbreak of Listeria monocytogenes is identified. The patient is managed inpatient with empiric high-dose amoxicillin for 14 days while awaiting blood culture results, along with fetal monitoring and supportive care to prevent dehydration and electrolyte imbalance. L. monocytogenes causes the clinical disease listeriosis and about 16% of cases occur in pregnant women. Increased susceptibility to listeriosis is partly due to reduced T cell immunity. Symptoms can range from asymptomatic to severe disease with neurological symptoms. Transplacental infection can occur with neonatal disease even in the absence of maternal symptoms. Maternal, perinatal, and neonatal morbidity and mortality are high. The best strategy is primary prevention by avoiding high-risk foods such as deli meat and soft cheeses, along with raw and unpasteurized foods. Safe food storage and preparation techniques also have a role in decreasing infection from cross contamination. Individual decision-making and a discussion of risks should guide individual food related decisions.

This chapter details the epidemiology, route of spread, prevalence, animal hosts relating to viral haemorrhagic fever (Lassa fever, Marburg disease, Ebola, Crimean-Congo haemorrhagic fever, dengue haemorrhagic fever, HFRS, hantaviruses). It gives information on symptoms, laboratory diagnosis, treatment and infection control.

This chapter details the differential diagnosis and laboratory diagnosis of organisms associated with glandular fever-like illness (EBV, CMV, adenoviruses, Toxoplasma gondii).

In the first chapter I introduce some methodological issues pertaining to the history of mental health: on the one hand, the issue of anachronism, the problem of retrospective diagnosis, on the other, the importance of maintaining intelligibility across cultures. When it comes to the ancient world, there are specific problems related to the nature of medical sources in Greek and Latin, and our limited access to the medical practices underlying them; in addition, the genre 'biography of disease' has its own pitfalls, namely those of attributing ‘essence’ to what appears, prima facie, to be most of all a construct: a disease concept or label such as phrenitis. Finally, in this chapter I consider the label phrenitis, its etymological meanings and the implications of the name vis-à-vis localization (chest? lungs? diaphragm? heart?) and mental life (mind? character? soul? mental capacities?). I also discuss the ‘Homeric’ appeal of the phrēn/phrenes, the name of the body part from which the label originates. The poetic archaism of phrēn/phrenes combined with its medical use made it both understandable as a generic term for mental life and specifically a ‘medical’ term to indicate the diaphragm, and contributed to making phrenitis a long-lasting disease concept.