Faget Sign

Description

Faget Sign: Relative bradycardia in association with fever (Temperature-pulse dissociation).

Originally described by Jean-Charles Faget in patients with yellow fever (1859). ‘Discordance entre la courbe du pouls et celle de la temperature dans la fièvre jaune.‘. Subsequently observed in multiple febrile illnesses especially intracellular bacterial infections


History

1859 – Faget published a review of the clinical historical accounts of multiple patients suffering from fever in the 1839, 1853 and 1858 Yellow fever epidemics in New Orleans.

..je pense être arrivé, au moins pour le diagnostic différentiel de la fièvre jaune et de nos fièvres des campagnes, à un fait générulde quelque importance; je veux parler de la décroissance régulière du pouls, du premier ou second, au quatrième ou cinquième jour, dans la vraie fièvre jaune, au moins de la Nouvelle-Orléans, décroissance régulière et rapide du pouls, qui est telle, d’après un relevé de près d’une centaine d’observations déjà, qu’on reconnaîtra peut-être que c’est là le véritable caractère de cette fièvre. Je ne sache pas, en effet, qu’il existe une autre maladie aiguë grave, dont la réaction fébrile tombe de si bonne heure, si rapidement, et avec une telle régularité.

…I think I have arrived, at least for the differential diagnosis of yellow fever and our rural fevers, to a general fact of some importance; I mean the regular decay of the pulse, from the first or second day, to the fourth or fifth day, in the true yellow fever, at least in New Orleans, a regular and rapid decrease of the pulse, according to almost a hundred observations already, we may recognize that this is the true character of this fever. I do not know, indeed, that there is another serious acute illness, whose febrile reaction falls so early, so quickly, and with such regularity.

Any intracellular organism has the potential to cause a relative bradycardia. Faget sign can be applied primarily to Gram negative intracellular bacteria, intracellular parasites and viruses responsible for hemorrhagic fever. One exception to this rule is Leptospira, which is a Gram negative extracellular organism associated with relative bradycardia

Faget sign has been recorded with Salmonella typhi (Typhoid Fever); Yellow Fever (viral hemorrhagic disease); Legionella; C. burnetii (Q Fever); Legionella; Chlamydia; Mycoplasma; Tularemia; Colorado Tick Fever (Coltivirus); Leshmaniasis; Brucellosis; Psittacosis and Dengue Fever


Associated Persons

References
  • Faget JC. Étude 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’épidémie de fièvre jaune de 1858. New Orleans, Impr. Franco-American 1859.
  • Fox S. Relative Bradycardia. Pediatric EM Morsels.
  • Ostergaard L, Huniche B, Andersen PL. Relative bradycardia in infectious diseases. J Infect. 1996 Nov;33(3):185-91. [PMID 8945708]
  • Mittal J, Estiverne C, Kothari N, Reddi A. Fever and Relative Bradycardia: A Case Presentation and Review of the Literature. Int J Case Rep Short Rev. 2015;1(1):4-8

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Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |

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