Fever of unknown origin diagnostic study of choice: Difference between revisions

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== Overview ==
==Overview==
Fever of unknown cause has many etiologies and in most cases the etiology is often unknown so there is no single gold standard diagnostic test rather the diagnostic tests depend upon the potential diagnostic clues in the history and physical examination of the patient.<ref name="ArnowFlaherty1997">{{cite journal|last1=Arnow|first1=Paul M|last2=Flaherty|first2=John P|title=Fever of unknown origin|journal=The Lancet|volume=350|issue=9077|year=1997|pages=575–580|issn=01406736|doi=10.1016/S0140-6736(97)07061-X}}</ref>


== Diagnostic Study of Choice ==
==Diagnostic Study of FUO==
The following three diagnostic modalities are done in all cases of FUO.


=== Study of choice ===
* Detailed history
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* Proper physical examination
* mandatory laboratory tests 


OR
Other diagnostic tests that are to be carried out depends upon the results of above three diagnostic modalities which are


The following result of [gold standard test] is confirmatory of [disease name]:
* CT scan
* [Result 1]
* MRI
* [Result 2]
* PET scan<ref name="pmid29452615">{{cite journal| author=Kouijzer IJE, Mulders-Manders CM, Bleeker-Rovers CP, Oyen WJG| title=Fever of Unknown Origin: the Value of FDG-PET/CT. | journal=Semin Nucl Med | year= 2018 | volume= 48 | issue= 2 | pages= 100-107 | pmid=29452615 | doi=10.1053/j.semnuclmed.2017.11.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29452615  }}</ref>
* Ultrasonography
* Bone marrow biopsy


OR
===Diagnostic Criteria===


[Name of the investigation] must be performed when:
* The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
* A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.


OR
According Petersdorf and Beeson diagnostic criteria proposed in 1991:<ref name="pmid22475734">{{cite journal| author=Hayakawa K, Ramasamy B, Chandrasekar PH| title=Fever of unknown origin:  an evidence-based review. | journal=Am J Med Sci | year= 2012 | volume= 344 | issue= 4 | pages= 307-16 | pmid=22475734 | doi=10.1097/MAJ.0b013e31824ae504 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22475734  }}</ref>


[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* Fever above 38.3° C (100.9° F)
* For more than three weeks
* No diagnosis after work up for at least three visits in outdoor or three days of stay in hospital


OR
<br />
 
The diagnostic study of choice for [disease name] is [name of the investigation].
 
OR
 
There is no single diagnostic study of choice for the diagnosis of [disease name].
 
OR
 
There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
 
OR
 
[Disease name] is primarily diagnosed based on the clinical presentation.
 
OR
 
Investigations:
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
 
==== The comparison of various diagnostic studies for [disease name] ====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|}
<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>
 
===== Diagnostic results =====
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
* [Finding 1]
* [Finding 2]
 
===== Sequence of Diagnostic Studies =====
The [name of investigation] must be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
 
OR
 
The various investigations must be performed in the following order:
* [Initial investigation]
* [2nd investigation]
 
=== Name of Diagnostic Criteria ===
 
'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''
 
[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
 
OR
 
There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
 
OR
 
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
 
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
[Disease name] may be diagnosed at any time if one or more of the following criteria are met:
* Criteria 1
* Criteria 2
* Criteria 3
 
OR
 
'''IF there are clear, established diagnostic criteria'''
 
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
 
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
'''IF there are no established diagnostic criteria'''
 
There are no established criteria for the diagnosis of [disease name].


==References==
==References==

Latest revision as of 20:58, 31 January 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Fever of unknown cause has many etiologies and in most cases the etiology is often unknown so there is no single gold standard diagnostic test rather the diagnostic tests depend upon the potential diagnostic clues in the history and physical examination of the patient.[1]

Diagnostic Study of FUO

The following three diagnostic modalities are done in all cases of FUO.

  • Detailed history
  • Proper physical examination
  • mandatory laboratory tests

Other diagnostic tests that are to be carried out depends upon the results of above three diagnostic modalities which are

  • CT scan
  • MRI
  • PET scan[2]
  • Ultrasonography
  • Bone marrow biopsy

Diagnostic Criteria

According Petersdorf and Beeson diagnostic criteria proposed in 1991:[3]

  • Fever above 38.3° C (100.9° F)
  • For more than three weeks
  • No diagnosis after work up for at least three visits in outdoor or three days of stay in hospital


References

  1. ↑ Arnow, Paul M; Flaherty, John P (1997). "Fever of unknown origin". The Lancet. 350 (9077): 575–580. doi:10.1016/S0140-6736(97)07061-X. ISSN 0140-6736.
  2. ↑ Kouijzer IJE, Mulders-Manders CM, Bleeker-Rovers CP, Oyen WJG (2018). "Fever of Unknown Origin: the Value of FDG-PET/CT". Semin Nucl Med. 48 (2): 100–107. doi:10.1053/j.semnuclmed.2017.11.004. PMID 29452615.
  3. ↑ Hayakawa K, Ramasamy B, Chandrasekar PH (2012). "Fever of unknown origin: an evidence-based review". Am J Med Sci. 344 (4): 307–16. doi:10.1097/MAJ.0b013e31824ae504. PMID 22475734.

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