[
    {
        "page": 1,
        "title": "Fiebre sin foco en el reci\u00e9n nacido y el lactante peque\u00f1o (Cap 202) , Fiebre de origen desconocido (204) , Fiebre generalidades (201)",
        "body": "<p>\n\n\n<meta http-equiv=\"Content-Type\" content=\"text\/html; charset=utf-8\" \/>\n<meta name=\"ProgId\" content=\"Word.DocumentW\" \/>\n<meta name=\"Generator\" content=\"Microsoft Word 15\" \/>\n<meta name=\"Originator\" content=\"Microsoft Word 15\" \/>\n<link rel=\"File-List\n\" href=\"file:\/\/\/C:\/Users\/Georgi\/AppData\/Local\/Temp\/msohtmlclip1\/01\/clip_filelist.xml\" \/>\n<link rel=\"Edit-Time-Data\n\" href=\"file:\/\/\/C:\/Users\/Georgi\/AppData\/Local\/Temp\/msohtmlclip1\/01\/clip_editdata.mso\" \/>\n\n<style>\nv\\:* {behavior:url(#default#VML);}\no\\:* {behavior:url(#default#VML);}\nw\\:* {behavior:url(#default#VML);}\n.shape {behavior:url(#default#VML);}\n<\/style>\n<xml>\n \n  \n \n<\/xml>\n<link rel=\"themeData\n\" href=\"file:\/\/\/C:\/Users\/Georgi\/AppData\/Local\/Temp\/msohtmlclip1\/01\/clip_themedata.thmx\" \/>\n<link rel=\"colorSchemeMapping\n\" href=\"file:\/\/\/C:\/Users\/Georgi\/AppData\/Local\/Temp\/msohtmlclip1\/01\/clip_colorschememapping.xml\" \/>\n<xml>\n \n  \n  \n   \n   \n   \n   \n   \n   \n   \n   \n   \n  \n  \n   \n   \n   \n   \n   \n   \n   \n   \n   \n   \n   \n  \n<\/xml><xml>\n \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n \n<\/xml>\n<style>\n\n<\/style>\n\n<style>\n \/* Style Definitions *\/\n table.MsoNormalTable\n\t{mso-style-name:\"Tabla normal\";\n\tmso-tstyle-rowband-size:0;\n\tmso-tstyle-colband-size:0;\n\tmso-style-noshow:yes;\n\tmso-style-priority:99;\n\tmso-style-parent:\"\";\n\tmso-padding-alt:0cm 5.4pt 0cm 5.4pt;\n\tmso-para-margin-top:0cm;\n\tmso-para-margin-right:0cm;\n\tmso-para-margin-bottom:8.0pt;\n\tmso-para-margin-left:0cm;\n\tline-height:107%;\n\tmso-pagination:widow-orphan;\n\tfont-size:11.0pt;\n\tfont-family:\"Calibri\",sans-serif;\n\tmso-ascii-font-family:Calibri;\n\tmso-ascii-theme-font:minor-latin;\n\tmso-hansi-font-family:Calibri;\n\tmso-hansi-theme-font:minor-latin;\n\tmso-bidi-font-family:\"Times New Roman\";\n\tmso-bidi-theme-font:minor-bidi;\n\tmso-font-kerning:1.0pt;\n\tmso-ligatures:standardcontextual;\n\tmso-fareast-language:EN-US;}\n<\/style>\n\n\n\n\n\n\n<\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Definici\u00f3n\ny consideraciones iniciales<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Fiebre sin foco<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">:\n     temperatura rectal \u226538 \u00b0C sin otro signo o s\u00edntoma en &lt;3 meses.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Importancia: riesgo de infecci\u00f3n bacteriana grave (IBG) vs\n     enfermedad viral autolimitada.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Grupos etarios:<\/span><\/li>\n <ul type=\"circlec\">\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Reci\u00e9n nacido: 0\u201328 d\u00edas.<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Lactante peque\u00f1o: 29\u201390 d\u00edas.<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Ni\u00f1os 3\u201336 meses (no abordados aqu\u00ed).<\/span><\/li>\n <\/ul>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Etiolog\u00eda y\nepidemiolog\u00eda<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">IBG<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\"> en 7\u201313%:<\/span><\/li>\n <ul type=\"circlec\">\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Infecci\u00f3n urinaria: 5\u201313%.<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Bacteriemia: 1\u20132%.<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Meningitis: 0,2\u20130,5%.<\/span><\/li>\n <\/ul>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Pat\u00f3genos principales<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">: <i>Escherichia\n     coli<\/i> y estreptococo grupo B.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Otros: <i>Klebsiella, Enterococcus, S. pneumoniae, N. meningitidis,\n     S. aureus, L. monocytogenes<\/i>.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">VHS neonatal<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">:\n     prevalencia 0,2\u20130,3%. Mortalidad elevada.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Virus frecuentes en febriles con buen aspecto<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">: VRS, enterovirus, influenza, parainfluenza, metaneumovirus,\n     adenovirus, parecovirus, rinovirus.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Manifestaciones\ncl\u00ednicas<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Pueden ser inespec\u00edficas: fiebre aislada o signos sist\u00e9micos.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Signos de alarma<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">:\n     hipotermia, taquipnea, apnea, taquicardia, mala perfusi\u00f3n, letargia,\n     irritabilidad, alteraci\u00f3n del tono, exantemas, petequias, cianosis.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Osteomielitis\/artritis s\u00e9ptica: pseudopar\u00e1lisis o irritabilidad\n     parad\u00f3jica.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Abordaje\ndiagn\u00f3stico<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">No hay consenso universal. Tradicionalmente: ingreso, hemograma,\n     urocultivo, hemocultivo, PL, antibi\u00f3ticos emp\u00edricos.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Actualmente: protocolos para <b>estratificaci\u00f3n de riesgo<\/b>.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:13.5pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Criterios\nde bajo riesgo (preguntado previamente en CONAREM)<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Rochester<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">: 0\u201360 d\u00edas.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Philadelphia<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">:\n     29\u201356 d\u00edas.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Boston<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">: 28\u201389 d\u00edas.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Requisitos comunes: buen aspecto, exploraci\u00f3n normal, cuidadores\n     disponibles, par\u00e1metros de laboratorio dentro de valores espec\u00edficos.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Diferencias: indicaci\u00f3n o no de PL y uso de antibi\u00f3ticos.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Nota<\/span><\/b><span style=\"font-size:12.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">: Lactantes\n&lt;28 d\u00edas casi siempre requieren evaluaci\u00f3n completa, antibi\u00f3ticos y\nhospitalizaci\u00f3n.<\/span><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Diagn\u00f3stico\nde laboratorio<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Hemograma<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">: poco espec\u00edfico. Leucocitos aislados no\n     predicen IBG.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Hemocultivo<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">:\n     negativo no descarta meningitis (\u224835% de meningitis sin hemocultivo\n     positivo).<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Orina<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">: an\u00e1lisis cl\u00e1sico (tira + microscop\u00eda)\n     vs mejorado (hemocit\u00f3metro, Gram).<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">LCR<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">: cultivo, Gram, glucosa, prote\u00ednas y\n     recuento celular. Valores normales dependen de la edad.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Problemas<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">: PL traum\u00e1tica, antibi\u00f3ticos previos \u2192\n     dificultan interpretaci\u00f3n.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">PCR<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">: \u00fatil para enterovirus y VHS, incluso\n     con antibi\u00f3ticos previos.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Estudios\nespec\u00edficos<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">VHS<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">: sospechar si convulsiones, ves\u00edculas,\n     ALT elevada, madre con primoinfecci\u00f3n, etc.<\/span><\/li>\n <ul type=\"circlec\">\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">AAP recomienda cultivos de mucosas, PCR de LCR y sangre, ALT\n      s\u00e9rica.<\/span><\/li>\n <\/ul>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Enterovirus<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">:\n     frecuente y benigno; PCR positiva se asocia a menos antibi\u00f3ticos y\n     estancia m\u00e1s corta.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Marcadores inflamatorios<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">:<\/span><\/li>\n <ul type=\"circlec\">\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">PCR y procalcitonina mejoran estratificaci\u00f3n de riesgo.<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Abordaje \u201c<b>step by step<\/b>\u201d: incluye edad &lt;21 d\u00edas, aspecto\n      grave, piuria, RAN &gt;10.000\/mm\u00b3, PCT &gt;0,5 ng\/ml, PCR &gt;20 mg\/L.<\/span><\/li>\n <\/ul>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Tratamiento<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Hospitalizados<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">:\n     siempre antimicrobianos emp\u00edricos.<\/span><\/li>\n <ul type=\"circlec\">\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Opci\u00f3n 1: cefalosporina 3\u00aa gen (cefepima\/ceftriaxona).<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Opci\u00f3n 2: cefalosporina 3\u00aa gen + ampicilina.<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Opci\u00f3n 3: aminogluc\u00f3sido + ampicilina.<\/span><\/li>\n <\/ul>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Lactantes 0\u201328 d\u00edas: incluir ampicilina (cubre <i>Listeria<\/i> y <i>Enterococcus<\/i>).<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Casos graves: a\u00f1adir vancomicina o carbapenemes seg\u00fan\n     epidemiolog\u00eda.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Sospecha de VHS<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">:\n     aciclovir 60 mg\/kg\/d\u00eda.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Duraci\u00f3n: depende del pat\u00f3geno y localizaci\u00f3n.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Alta\nhospitalaria<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Antes: tras 48h de cultivos negativos.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Ahora: muchos autores aceptan 24\u201336h, dado que &gt;90% de\n     hemocultivos y LCR positivos lo son en ese plazo.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">En sospecha de VHS: esperar resultados de PCR antes de alta.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Pron\u00f3stico<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">La mayor\u00eda de lactantes con buen aspecto evolucionan\n     favorablemente.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Mayor mortalidad y secuelas:<\/span><\/li>\n <ul type=\"circlec\">\n  <li style=\"line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">VHS diseminado<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n      &quot;Times New Roman&quot;,serif\">:\n      mortalidad 27\u201331%.<\/span><\/li>\n  <li style=\"line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">VHS SNC<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">: mortalidad 4\u20136%,\n      secuelas neurol\u00f3gicas 69%.<\/span><\/li>\n  <li style=\"line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Meningitis bacteriana<\/span><\/b><span style=\"font-size:12.0pt;\n      font-family:&quot;Times New Roman&quot;,serif\">:\n      mortalidad 4\u201315%, depende del germen.<\/span><\/li>\n <\/ul>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">La mayor\u00eda de sobrevivientes alcanzan desarrollo normal a largo\n     plazo.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p class=\"MsoNormalM\"><br \/><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p class=\"MsoNormalM\">\n\n\n<meta http-equiv=\"Content-Type\" content=\"text\/html; charset=utf-8\" \/>\n<meta name=\"ProgId\" content=\"Word.DocumentW\" \/>\n<meta name=\"Generator\" content=\"Microsoft Word 15\" \/>\n<meta name=\"Originator\" content=\"Microsoft Word 15\" \/>\n<link rel=\"File-List\n\" href=\"file:\/\/\/C:\/Users\/Georgi\/AppData\/Local\/Temp\/msohtmlclip1\/01\/clip_filelist.xml\" \/>\n<link rel=\"Edit-Time-Data\n\" href=\"file:\/\/\/C:\/Users\/Georgi\/AppData\/Local\/Temp\/msohtmlclip1\/01\/clip_editdata.mso\" \/>\n\n<style>\nv\\:* {behavior:url(#default#VML);}\no\\:* {behavior:url(#default#VML);}\nw\\:* {behavior:url(#default#VML);}\n.shape {behavior:url(#default#VML);}\n<\/style>\n<xml>\n \n  \n \n<\/xml>\n<link rel=\"themeData\n\" href=\"file:\/\/\/C:\/Users\/Georgi\/AppData\/Local\/Temp\/msohtmlclip1\/01\/clip_themedata.thmx\" \/>\n<link rel=\"colorSchemeMapping\n\" href=\"file:\/\/\/C:\/Users\/Georgi\/AppData\/Local\/Temp\/msohtmlclip1\/01\/clip_colorschememapping.xml\" \/>\n<xml>\n \n  \n  \n  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\n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n \n<\/xml>\n<style>\n\n<\/style>\n\n<style>\n \/* Style Definitions *\/\n table.MsoNormalTable\n\t{mso-style-name:\"Tabla normal\";\n\tmso-tstyle-rowband-size:0;\n\tmso-tstyle-colband-size:0;\n\tmso-style-noshow:yes;\n\tmso-style-priority:99;\n\tmso-style-parent:\"\";\n\tmso-padding-alt:0cm 5.4pt 0cm 5.4pt;\n\tmso-para-margin-top:0cm;\n\tmso-para-margin-right:0cm;\n\tmso-para-margin-bottom:8.0pt;\n\tmso-para-margin-left:0cm;\n\tline-height:107%;\n\tmso-pagination:widow-orphan;\n\tfont-size:11.0pt;\n\tfont-family:\"Calibri\",sans-serif;\n\tmso-ascii-font-family:Calibri;\n\tmso-ascii-theme-font:minor-latin;\n\tmso-hansi-font-family:Calibri;\n\tmso-hansi-theme-font:minor-latin;\n\tmso-bidi-font-family:\"Times New Roman\";\n\tmso-bidi-theme-font:minor-bidi;\n\tmso-font-kerning:1.0pt;\n\tmso-ligatures:standardcontextual;\n\tmso-fareast-language:EN-US;}\n<\/style>\n\n\n\n\n\n\n<\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:24.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Resumen\nt\u00e9cnico \u2013 Fiebre de origen desconocido<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><i><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">(Cap\u00edtulo 204, Nelson 21\u00aa edici\u00f3n \u2013 condensado\npara preparaci\u00f3n CONAREM)<\/span><\/i><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Definici\u00f3n<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">FOD<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">: temperatura &gt;38 \u00b0C documentada, sin\n     causa identificada tras \u22658 d\u00edas de evaluaci\u00f3n m\u00e9dica.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Diferencia con fiebre sin origen evidente (FSOE)<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">: duraci\u00f3n; la FSOE &lt;7 d\u00edas puede progresar a FOD.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:13.5pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Subtipos de\nFOD (tabla 204.1)<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Cl\u00e1sica<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">: &gt;38 \u00b0C, &gt;3 semanas, \u22652 visitas\n     ambulatorias o \u22651 semana hospitalizado.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Asociada a la asistencia sanitaria<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">: &gt;38 \u00b0C, &gt;1 semana, cultivos negativos a las 48 h.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">En inmunodeficiencias<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">:\n     &gt;38 \u00b0C, &gt;1 semana.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Relacionada con VIH<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">:\n     &gt;38 \u00b0C, &gt;3 semanas.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Etiolog\u00eda<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Infecciosa<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">:\n     principal causa (abscesos, tuberculosis, salmonelosis, brucelosis,\n     rickettsiosis, endocarditis, osteomielitis, infecciones virales como EBV,\n     CMV, hepatitis, VIH, parasitosis \u2013 malaria, toxoplasmosis\u2013).<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Reumatol\u00f3gica\/Autoinmunitaria<\/span><\/b><span style=\"font-size:\n     12.0pt;font-family:&quot;Times New Roman&quot;,serif\">:\n     artritis idiop\u00e1tica juvenil (AIJ), lupus eritematoso sist\u00e9mico, fiebre\n     reum\u00e1tica, enfermedad de Kawasaki, enfermedad inflamatoria intestinal.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Oncol\u00f3gica<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">:\n     leucemias, linfomas, neuroblastoma, tumor de Wilms.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Autoinflamatoria\/Familiar<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">:\n     fiebre mediterr\u00e1nea familiar, s\u00edndrome de Muckle-Wells, fiebre peri\u00f3dica.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Miscel\u00e1nea<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">:\n     fiebre medicamentosa, fiebre facticia, enfermedad de Addison, sarcoidosis,\n     hepatopat\u00eda granulomatosa, trombosis venosa profunda, tiroiditis.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Segoe UI Emoji&quot;,sans-serif\">\ud83d\udd39<\/span><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\"> Nota: en pa\u00edses desarrollados, la introducci\u00f3n de PCR, mejores cultivos\ny mayor reconocimiento de autoinmunidad han reducido casos de FOD verdaderos;\nen pa\u00edses en desarrollo predominan a\u00fan las causas infecciosas.<\/span><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Presentaci\u00f3n\ncl\u00ednica<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">La FOD en ni\u00f1os suele ser una <b>manifestaci\u00f3n at\u00edpica de\n     enfermedades comunes<\/b>.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Ejemplo: AIJ puede iniciar como FOD.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Evaluaci\u00f3n requiere <b>repetici\u00f3n frecuente de anamnesis,\n     exploraci\u00f3n y pruebas<\/b>.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Duraci\u00f3n &gt;6 meses<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">\n     sugiere enfermedad granulomatosa, autoinflamatoria o autoinmunitaria.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Diagn\u00f3stico<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:13.5pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Anamnesis<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Buscar: inicio, patr\u00f3n, duraci\u00f3n, respuesta a antit\u00e9rmicos, viajes,\n     contacto con animales, vacunaciones, medicamentos, antecedentes\n     familiares.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Exposiciones: zoonosis (mascotas, animales salvajes), garrapatas,\n     aguas contaminadas.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Antecedentes gen\u00e9ticos: fiebre mediterr\u00e1nea familiar, s\u00edndrome de\n     hiper-IgD, disautonom\u00eda familiar.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Diferenciar <b>seudo-FOD<\/b>: episodios virales repetidos mal\n     interpretados como fiebre persistente.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:13.5pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Exploraci\u00f3n\nf\u00edsica<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Examen completo y repetido.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Piel y mucosas: exantemas, conjuntivitis, uve\u00edtis, petequias.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Linfadenopat\u00edas, esplenomegalia, soplos, masas abdominales.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Exploraci\u00f3n osteoarticular: dolor \u00f3seo \u2192 osteomielitis, tumor.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Hallazgos oculares espec\u00edficos: uve\u00edtis (LES, AIJ, Kawasaki,\n     Beh\u00e7et), coriorretinitis (CMV, toxoplasma, s\u00edfilis).<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:13.5pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Laboratorio\ninicial<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Hemograma y an\u00e1lisis de orina.<\/span><\/li>\n <ul type=\"circlec\">\n  <li style=\"line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">RAN &lt;5.000\/\u03bcl<\/span><\/b><span style=\"font-size:12.0pt;\n      font-family:&quot;Times New Roman&quot;,serif\">:\n      descarta infecci\u00f3n bacteriana grave, excepto fiebre tifoidea.<\/span><\/li>\n  <li style=\"line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">PMN &gt;10.000\/\u03bcl o bandas &gt;500\/\u03bcl<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">: sugiere infecci\u00f3n bacteriana.<\/span><\/li>\n <\/ul>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">VSG y PCR: reactantes de fase aguda (\u00fatiles para autoinmunidad e\n     infecci\u00f3n).<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Hemocultivos (aerobios, m\u00faltiples si sospecha\n     endocarditis\/osteomielitis).<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Urocultivo en todos los casos.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">PPD o IGRA en sospecha de TB.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Serolog\u00edas selectivas: EBV, CMV, toxoplasma, brucella, rickettsias,\n     etc.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:13.5pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Estudios de\nimagen y procedimientos<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Rx t\u00f3rax\/senos\/mastoides seg\u00fan cl\u00ednica.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Ecograf\u00eda abdominal para abscesos.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">TC\/RM corporal total \u2192 detectar neoplasias, abscesos ocultos.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Medicina nuclear: galio, Tc-99, PET-FDG para focos inflamatorios o\n     tumores.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Biopsias dirigidas: m\u00e9dula \u00f3sea (leucemia, micobacterias, hongos),\n     endoscopias, laparoscopia.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Tratamiento<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">No emp\u00edrico de rutina<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">: solo\n     tras diagn\u00f3stico o sospecha fuerte.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Evitar antibi\u00f3ticos emp\u00edricos ciegos (pueden enmascarar\n     endocarditis u osteomielitis).<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Excepci\u00f3n<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">: iniciar antituberculosos en pacientes\n     graves con sospecha de TB diseminada.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Antipir\u00e9ticos se usan para control sintom\u00e1tico.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Pron\u00f3stico<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Mejor en ni\u00f1os que en adultos.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">En muchos casos la fiebre desaparece espont\u00e1neamente.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Hasta 25% persisten sin diagn\u00f3stico.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Mortalidad y morbilidad dependen de la enfermedad subyacente.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Conceptos\nya preguntados en CONAREM<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Definici\u00f3n y criterios de FOD<\/span><\/b><span style=\"font-size:\n     12.0pt;font-family:&quot;Times New Roman&quot;,serif\"> (preguntado\n     previamente en CONAREM).<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Principales etiolog\u00edas infecciosas (TB, brucelosis, endocarditis,\n     abscesos)<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\"> (preguntado previamente en CONAREM).<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Conceptos\nno preguntados (desarrollados m\u00e1s aqu\u00ed)<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Subtipos de FOD (cl\u00e1sica, asociada a cuidados de salud,\n     inmunodeficiencias, VIH).<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Diferenciaci\u00f3n FSOE vs FOD.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">FOD de larga duraci\u00f3n (&gt;6 meses) \u2192 enfermedades\n     granulomatosas\/autoinflamatorias.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Uso de im\u00e1genes avanzadas (PET-TC, RM corporal total).<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Seudo-FOD y fiebre facticia.<\/span><\/li><\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div><span style=\"font-family: &quot;Times New Roman&quot;, serif; font-size: 16px;\"><br \/><\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<meta http-equiv=\"Content-Type\" content=\"text\/html; charset=utf-8\" \/>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<meta name=\"ProgId\" content=\"Word.DocumentW\" \/>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<meta name=\"Generator\" content=\"Microsoft Word 15\" \/>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<meta name=\"Originator\" content=\"Microsoft Word 15\" \/>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<link rel=\"File-List\n\" href=\"file:\/\/\/C:\/Users\/Georgi\/AppData\/Local\/Temp\/msohtmlclip1\/01\/clip_filelist.xml\" \/>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<link rel=\"Edit-Time-Data\n\" href=\"file:\/\/\/C:\/Users\/Georgi\/AppData\/Local\/Temp\/msohtmlclip1\/01\/clip_editdata.mso\" \/>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<style>\nv\\:* {behavior:url(#default#VML);}\no\\:* {behavior:url(#default#VML);}\nw\\:* {behavior:url(#default#VML);}\n.shape {behavior:url(#default#VML);}\n<\/style>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<xml>\n \n  \n \n<\/xml>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<link rel=\"themeData\n\" href=\"file:\/\/\/C:\/Users\/Georgi\/AppData\/Local\/Temp\/msohtmlclip1\/01\/clip_themedata.thmx\" \/>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<link rel=\"colorSchemeMapping\n\" href=\"file:\/\/\/C:\/Users\/Georgi\/AppData\/Local\/Temp\/msohtmlclip1\/01\/clip_colorschememapping.xml\" \/>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<xml>\n \n  \n  \n   \n   \n   \n   \n   \n   \n   \n   \n   \n  \n  \n   \n   \n   \n   \n   \n   \n   \n   \n   \n   \n   \n  \n<\/xml>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<xml>\n \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n \n<\/xml>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<style>\n\n<\/style>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<style>\n \/* Style Definitions *\/\n table.MsoNormalTable\n\t{mso-style-name:\"Tabla normal\";\n\tmso-tstyle-rowband-size:0;\n\tmso-tstyle-colband-size:0;\n\tmso-style-noshow:yes;\n\tmso-style-priority:99;\n\tmso-style-parent:\"\";\n\tmso-padding-alt:0cm 5.4pt 0cm 5.4pt;\n\tmso-para-margin-top:0cm;\n\tmso-para-margin-right:0cm;\n\tmso-para-margin-bottom:8.0pt;\n\tmso-para-margin-left:0cm;\n\tline-height:107%;\n\tmso-pagination:widow-orphan;\n\tfont-size:11.0pt;\n\tfont-family:\"Calibri\",sans-serif;\n\tmso-ascii-font-family:Calibri;\n\tmso-ascii-theme-font:minor-latin;\n\tmso-hansi-font-family:Calibri;\n\tmso-hansi-theme-font:minor-latin;\n\tmso-bidi-font-family:\"Times New Roman\";\n\tmso-bidi-theme-font:minor-bidi;\n\tmso-font-kerning:1.0pt;\n\tmso-ligatures:standardcontextual;\n\tmso-fareast-language:EN-US;}\n<\/style>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:24.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Resumen\nt\u00e9cnico \u2013 Fiebre<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><i><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">(Cap\u00edtulo 201, Nelson 21\u00aa edici\u00f3n \u2013 condensado\npara preparaci\u00f3n CONAREM)<\/span><\/i><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Definici\u00f3n<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Fiebre<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">: temperatura rectal \u226538 \u00b0C.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Hiperpirexia<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">:\n     &gt;40 \u00b0C.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Temperatura corporal normal: 36,6\u201337,9 \u00b0C (rectal).<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Fiebre es un <b>s\u00edntoma de enfermedad subyacente<\/b>, no\n     diagn\u00f3stico en s\u00ed.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Fisiopatolog\u00eda<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Regulaci\u00f3n en <b>hipot\u00e1lamo pre\u00f3ptico<\/b>: sensores centrales y\n     perif\u00e9ricos.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Respuestas: redistribuci\u00f3n sangu\u00ednea, sudoraci\u00f3n, regulaci\u00f3n\n     h\u00eddrica (vasopresina), conductas (buscar fr\u00edo\/calor).<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Mecanismos<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">:<\/span><\/li>\n <ol start=\"1\">\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Pir\u00f3genos \u2192 aumento del \u201cset point\u201d hipotal\u00e1mico.<\/span><\/li>\n  <ul type=\"squares\">\n   <li style=\"line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">End\u00f3genos<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n       &quot;Times New Roman&quot;,serif\">:\n       IL-1, IL-6, TNF-\u03b1, IFN-\u03b2, IFN-\u03b3, prostaglandina E\u2082.<\/span><\/li>\n   <li style=\"line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Ex\u00f3genos<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n       &quot;Times New Roman&quot;,serif\">:\n       microbios, endotoxinas, f\u00e1rmacos.<\/span><\/li>\n  <\/ul>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Producci\u00f3n excesiva de calor (ej.: intoxicaci\u00f3n salic\u00edlica,\n      hipertermia maligna).<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">P\u00e9rdida defectuosa de calor (ej.: displasia ectod\u00e9rmica, golpe de\n      calor).<\/span><\/li>\n <\/ol>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Etiolog\u00eda<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Infecciosa<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">:\n     viral (resfriado, influenza, GE aguda) y bacteriana (otitis media,\n     faringitis, sinusitis).<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Inflamatoria<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">:\n     autoinmunes y autoinflamatorias.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Neopl\u00e1sica<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Miscel\u00e1nea<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">:\n     fiebre medicamentosa, fiebre facticia, hipertermia central.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Patrones de\nfiebre<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Intermitente<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">: con\n     periodos afebriles (ej. malaria).<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">S\u00e9ptica\/H\u00e9ctica<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">:\n     fluctuaciones extremas.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Sostenida<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">: persistente, variaci\u00f3n &lt;0,5 \u00b0C\/d\u00eda.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Remitente<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">: persistente, variaci\u00f3n &gt;0,5 \u00b0C\/d\u00eda.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Recurrente<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">:\n     periodos febriles alternando con normales (ej. malaria, fiebre recurrente,\n     brucelosis).<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Bif\u00e1sica<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">: dos picos en un curso (ej. polio,\n     dengue, leptospirosis).<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Peri\u00f3dica<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">: fiebre con periodicidad regular\n     (neutropenia c\u00edclica, fiebre mediterr\u00e1nea familiar, s\u00edndrome de hiper-IgD,\n     TRAPS, Muckle-Wells).<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Doble cotidiana<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">: dos\n     picos en 24 h (artritis inflamatoria).<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Manifestaciones\ncl\u00ednicas<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Var\u00edan: desde malestar leve hasta cuadro grave.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">S\u00edntomas acompa\u00f1antes: escalofr\u00edos, rubefacci\u00f3n, irritabilidad,\n     anorexia.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Fiebre + petequias + mal aspecto<\/span><\/b><span style=\"font-size:\n     12.0pt;font-family:&quot;Times New Roman&quot;,serif\">:\n     meningococemia, fiebre maculosa, endocarditis aguda.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Card\u00edaco<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">:<\/span><\/li>\n <ul type=\"circlec\">\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Taquicardia (10 lpm\/\u00b0C &gt;2 meses).<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Bradicardia relativa \u2192 fiebre tifoidea, brucelosis, leptospirosis,\n      fiebre medicamentosa.<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Bradicardia por da\u00f1o mioc\u00e1rdico \u2192 fiebre reum\u00e1tica, Lyme,\n      miocarditis viral, endocarditis.<\/span><\/li>\n <\/ul>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Evaluaci\u00f3n\ndiagn\u00f3stica<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Historia cl\u00ednica<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">:\n     inicio, patr\u00f3n, s\u00edntomas, contactos, viajes, medicamentos, vacunas,\n     inmunodeficiencias.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Exploraci\u00f3n f\u00edsica<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">:\n     completa, con \u00e9nfasis en hallazgos cut\u00e1neos, respiratorios, neurol\u00f3gicos.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Laboratorio seg\u00fan caso<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">\n     (tabla 201.2):<\/span><\/li>\n <ul type=\"circlec\">\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Hemograma, hemocultivo, PCR, VSG, procalcitonina.<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Orina: an\u00e1lisis y cultivo.<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">LCR si sospecha meningitis.<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Ant\u00edgenos r\u00e1pidos (influenza, VRS, estreptococo grupo A).<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Coprocultivo\/NAAT si diarrea con sangre.<\/span><\/li>\n <\/ul>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Imagen<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">: Rx t\u00f3rax (respiratorio), otras seg\u00fan\n     sospecha.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Tratamiento<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">La fiebre <b>por s\u00ed sola no causa da\u00f1o cerebral<\/b> (salvo golpe de\n     calor o estado epil\u00e9ptico febril).<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Beneficios: inhibe replicaci\u00f3n microbiana, potencia respuesta\n     inmune.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Indicaci\u00f3n de antipir\u00e9ticos<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">:\n     malestar, grupos de riesgo (cardiopat\u00eda, neumopat\u00eda cr\u00f3nica, anemias,\n     errores metab\u00f3licos).<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">F\u00e1rmacos<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">:<\/span><\/li>\n <ul type=\"circlec\">\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Paracetamol: 10\u201315 mg\/kg\/dosis cada 4 h.<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Ibuprofeno (&gt;6 meses): 5\u201310 mg\/kg\/dosis cada 8 h.<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Seguros si se usan correctamente (efectos adversos:\n      hepatotoxicidad con paracetamol, GI\/renales con ibuprofeno).<\/span><\/li>\n <\/ul>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Medidas f\u00edsicas (ba\u00f1os tibios, mantas fr\u00edas) no son eficaces.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Hidrataci\u00f3n siempre esencial.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Tratar la causa espec\u00edfica (ej.: antibi\u00f3ticos en infecciones, IGIV\n     en Kawasaki).<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Pron\u00f3stico<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Generalmente favorable.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Hiperpirexia (&gt;41 \u00b0C) suele indicar patolog\u00eda grave\n     (hipotal\u00e1mica, medicamentosa, golpe de calor).<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Fiebres &lt;36 \u00b0C pueden asociarse con sepsis grave o\n     hipotiroidismo.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Conceptos\nya preguntados en CONAREM<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Definici\u00f3n de fiebre e hiperpirexia<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\"> (preguntado previamente en CONAREM).<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Patrones de fiebre (intermitente, remitente, recurrente, s\u00e9ptica,\n     bif\u00e1sica, peri\u00f3dica)<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">\n     (preguntado previamente en CONAREM).<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Indicaciones de antipir\u00e9ticos<\/span><\/b><span style=\"font-size:\n     12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n     (preguntado previamente en CONAREM).<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Conceptos\nno preguntados (desarrollados m\u00e1s aqu\u00ed)<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Diferencias fisiopatol\u00f3gicas entre mecanismos de fiebre (pir\u00f3genos,\n     exceso de calor, p\u00e9rdida defectuosa).<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Fiebre facticia (autoinducida) y doble cotidiana.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Bradicardia relativa como signo diagn\u00f3stico.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Hiperpirexia como marcador de enfermedades graves no infecciosas.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p class=\"MsoNormalM\">&nbsp;<\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<br \/>",
        "footer": "P\u00e1gina 1"
    }
]