Of course, we still face diagnostic uncertainty in many patients who develop new symptoms or signs during their stay in the ICU (for example, respiratory deterioration or fever).
Clinical treatment failure is the opposite of clinical cure and defined as deterioration, persistent fever and/or symptoms of UTI (less than 2 points improvement on a 0 through 5 points severity score) or relapse of UTI with the same uropathogen for which additional antimicrobial treatment is prescribed.
On day 23 after admission, he was transferred to our teaching hospital in Nice because of clinical deterioration and persistent fever.
For one patient with an increase of fever, deterioration of general health status, and an increase in CRP levels from 40 to 60 μg/ml two days after the first consultation, antibiotic treatment had been prescribed without an evaluative chest x-ray.
In two out of five patients with a pre-existing valvulopathy, valvular dysfunction occurred (left ventricular function deterioration due to Q fever endocarditis, and a new dysfunction of an artificial cardiac valve, as a consequence of Q fever endocarditis).
Lemierre's syndrome, which mainly affects young patients without any previous medical history, consists of a combination of fever, shivering, deterioration of the general condition, and pain and/or cervical tumefaction along the sterno-cleido-mastoid muscle, resulting from a suppurative thrombophlebitis of the tonsillar and peri-tonsillar veins that can extend to the internal jugular vein.
Dream of Ding Village, a novel by Yan Lianke, one of the most prolific and bravest authors to come from China (periodically banned by the government), brings us a disturbing chronicle of one village's deterioration caused by "the spreading fever" (as Aids was called by the local peasants).
Persistence of fever with clinical deterioration or infectious disease progression should be distinguished from persistence of fever in a clinically stable patient.
There were 2 significant adverse neurologic events that occurred, including a flare of MS during mobilization and an episode of irreversible neurologic deterioration after HDIT associated with fever.
In patients with sustained bacteremia and/or persistent fever and clinical deterioration, a portal of entry requiring specific treatment should be sought.
There may also be a history of acute illness followed by sudden deterioration in knee function, with fever and chills [14, 16].
