Faget's sign: Difference between revisions
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===Causes in Alphabetical Order=== | ===Causes in Alphabetical Order=== | ||
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* [[Anaphylaxis]] | * [[Anaphylaxis]] | ||
* [[Atypical pneumonia]] | * [[Atypical pneumonia]] | ||
Latest revision as of 20:55, 10 January 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: pulse-temperature deficit; relative bradycardia
Overview
| Table 1. Physiologic pulse-temperature relationship | ||
|---|---|---|
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Body Temperature
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Pulse Rate
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Pulse-Temperature Deficit
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| Table 2. Classic infectious etiologies associated with relative bradycardia | ||
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Faget's sign refers to a significant pulse-temperature deficit relative to the degree of fever.
Historical Perspective
Feget's sign is named after Jean Charles Faget, who characterized the unusual constellation of fever and bradycardia in 1859.[1]
Pathophysiology
Physiologically, fever is accompanied by tachycardia rather than bradycardia. For every degree of temperature elevation in degrees Fahrenheit, there is a commensurate increase in pulse rate of 10 beats per minute. This physiologic relationship between temperature and pulse rate is known as Liebermeister's rule (Table 1). When fever is associated with bradycardia, it is referred to as Faget's sign.
Clinical Significance
Abnormalities in the pulse-temperature relationship may be indiscernible when the body temperature falls below 102°F. Relative bradycardia should not be applied to patients with paced rhythms or advanced AV block or to those taking beta-blockers. Digoxin, angiotensin-converting enzyme inhibitors, and dihydropyridine calcium channel blockers do not affect pulse-temperature relationships as do beta-blockers.[2]
Relative bradycardia may aid differential diagnosis in selected clinical contexts. Faget's sign may be used to discriminate Legionella pneumophila from Mycoplasma pneumoniae in community-acquired pneumonias.[3][4] When relative bradycardia is associated with fever of unknown origin, certain non-infectious causes including central nervous system lesions, lymphomas, drug fever, factitious fever, and beta-blockers should be considered in addition to the infectious etiologies (Table 2).
Causes
Common Causes
- Brucellosis
- Chlamydia
- Colorado tick fever virus
- Coxiella burnetii
- Dengue Fever[5]
- Drug fever
- Legionella[3][6]
- Leptospirosis
- Leishmaniasis
- Mycoplasma[3]
- Psittacosis
- Tularemia
- Typhoid fever
- Yellow Fever[2][7]
Causes by Organ System
| Cardiovascular | No underlying causes |
| Chemical/Poisoning | No underlying causes |
| Dental | No underlying causes |
| Dermatologic | No underlying causes |
| Drug Side Effect | Beta blocker, drug fever |
| Ear Nose Throat | No underlying causes |
| Endocrine | No underlying causes |
| Environmental | No underlying causes |
| Gastroenterologic | No underlying causes |
| Genetic | Cyclic neutropenia |
| Hematologic | Babesiosis, cyclic neutropenia, lymphoma, malaria |
| Iatrogenic | No underlying causes |
| Infectious Disease | Atypical pneumonia, babesiosis, brucellosis, campylobacter fetus, chagas disease, chlamydia, chlamydophila psittaci, colorado tick fever virus, coxiella burnetii, cytomegalovirus mononucleosis, dengue fever, ehrlichia canis, enteric fever, francisella tularensis, group A streptococcus, Guanarito virus, Junin virus, Legionnaires' disease, leishmaniasis, leptospirosis, listeria monocytogenes, Machupo virus, malaria, mycoplasma, orientia tsutsugamushi, plasmodium vivax , Q fever, rickettsiosis, rickettsia typhi, rocky mountain spotted fever, salmonella enterica, typhoid fever, viral hemorrhagic fever, yellow fever |
| Musculoskeletal/Orthopedic | No underlying causes |
| Neurologic | Central nervous system lesion |
| Nutritional/Metabolic | No underlying causes |
| Obstetric/Gynecologic | No underlying causes |
| Oncologic | Lymphoma |
| Ophthalmologic | No underlying causes |
| Overdose/Toxicity | No underlying causes |
| Psychiatric | No underlying causes |
| Pulmonary | Atypical pneumonia |
| Renal/Electrolyte | No underlying causes |
| Rheumatology/Immunology/Allergy | Anaphylaxis |
| Sexual | No underlying causes |
| Trauma | No underlying causes |
| Urologic | No underlying causes |
| Miscellaneous | Factitious fever |
Causes in Alphabetical Order
- Anaphylaxis
- Atypical pneumonia
- Babesiosis
- Beta blocker
- Brucellosis
- Campylobacter fetus
- Central nervous system lesion
- Chagas disease
- Chlamydia
- Chlamydophila psittaci
- Colorado tick fever virus
- Coxiella burnetii
- Cyclic neutropenia
- Cytomegalovirus mononucleosis
- Dengue fever
- Drug fever
- Ehrlichia canis
- Enteric fever
- Factitious fever
- Francisella tularensis
- Group A streptococcus
- Guanarito virus
- Junin virus
- Legionnaires' disease
- Leishmaniasis
- Leptospirosis
- Listeria monocytogenes
- Lymphoma
- Machupo virus
- Malaria
- Murine typhus
- Mycoplasma
- Orientia tsutsugamushi
- Plasmodium vivax
- Q fever
- Rickettsia typhi
- Rickettsiosis
- Rocky mountain spotted fever
- Salmonella enterica
- Typhoid fever
- Viral hemorrhagic fever
- Yellow fever
References
- ↑ Jean-Charles Faget. Études médicale de quelques questions importantes pour la Louisiane, et exposé succinct d’une endémie paludéenne de forme catarrhale qui a sévi à la Nouvelle-Orléans, particulièrement sur les enfants, pendant l’epidémie de fièvre jaune de 1858. New Orleans, 1859.
- ↑ 2.0 2.1 Cunha, BA. (2000). "The diagnostic significance of relative bradycardia in infectious disease". Clin Microbiol Infect. 6 (12): 633–4. PMID 11284920. Unknown parameter
|month=ignored (help) - ↑ 3.0 3.1 3.2 Johnson, DH.; Cunha, BA. (1993). "Atypical pneumonias. Clinical and extrapulmonary features of Chlamydia, Mycoplasma, and Legionella infections". Postgrad Med. 93 (7): 69–72, 75–6, 79–82. PMID 8493198. Unknown parameter
|month=ignored (help) - ↑ Cunha, B. A.; Quintiliani, R. (1979-09). "The atypical pneumonias: a diagnostic and therapeutic approach". Postgraduate Medicine. 66 (3): 95–102. ISSN 0032-5481. PMID 471855. Check date values in:
|date=(help) - ↑ Senanayake, S. (2006). "Dengue fever and dengue haemorrhagic fever--a diagnostic challenge". Aust Fam Physician. 35 (8): 609–12. PMID 16894436. Unknown parameter
|month=ignored (help) - ↑ Erdogan, H.; Erdogan, A.; Lakamdayali, H.; Yilmaz, A.; Arslan, H. (2010). "Travel-associated Legionnaires disease: clinical features of 17 cases and a review of the literature". Diagn Microbiol Infect Dis. 68 (3): 297–303. doi:10.1016/j.diagmicrobio.2010.07.023. PMID 20955914. Unknown parameter
|month=ignored (help) - ↑ Wittesjö, B.; Björnham, A.; Eitrem, R. (1999). "Relative bradycardia in infectious diseases". J Infect. 39 (3): 246–7. PMID 10714809. Unknown parameter
|month=ignored (help)