Fever of unknown origin causes: Difference between revisions

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| style="vertical-align: middle; padding: 5px;" align=center | [[File:Siren.gif|30px|link=Fever of unknown origin resident survival guide]]
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| style="vertical-align: middle; padding: 5px;" align=center | [[Fever of unknown origin resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
| style="vertical-align: middle; padding: 5px;" align="center" |[[Fever of unknown origin resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
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{{Fever of unknown origin}}
{{Fever of unknown origin}}
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{{SK}} febris continua e causa ignota; febris e causa ignota; febris E.C.I.; FUO; PUO; pyrexia of unknown origin
{{SK}} febris continua e causa ignota; febris e causa ignota; febris E.C.I.; FUO; PUO; pyrexia of unknown origin
==Overview==
Classic FUO may be caused by infection, neoplasia, inflammatory , miscellaneous diseases, and undiagnosed illness.Common causes of neutropenic FUO include bacterial, fungal and viral infection.Causes of nosocomial FUO are related to hospital setting such as drugs, infections acquired during hospitalization and complications that occur during and after surgery.This may due to acute infection from HIV itself earlier or later due to [[Opportunistic infection|opportunistic]] bacterial, fungal and viral infections such as [[mycobacteria]], [[Toxoplasmosis|toxoplasma]] etc.


==Causes==
==Causes==
=== Common Causes===
Etiology is different for different categories of FUO:
*[[Extrapulmonary tuberculosis]]<ref name="Harrison">[http://books.mcgraw-hill.com/medical/harrisons/ Harrison's Principles of Internal Medicine] 16th Edition, The McGraw-Hill Companies, ISBN 0-07-140235-7</ref> - most frequent cause of fever of unknown origin.
*[[Drug fever]] - adverse reactions of medications should always be considered as an important cause before starting actual evaluation for FUO.
*[[Histoplasmosis]]
*[[Coccidioidomycosis]]
*[[Blastomycosis]] - any systemic granulomatous disease can be a cause of FUO.
*[[Sarcoidosis]] - one of the important differential diagnosis for FUO in African-american population.
*[[Lymphoma]] - most common cause of FUO in adults.
*[[Pulmonary embolism]]
*[[Deep venous thrombosis]]
*[[Endocarditis]] - although it is a rare cause, it is always important to think over it as one of the differential diagnosis.
*Factitious [[fever]]<ref name="Mandell">[http://www.ppidonline.com/ Mandell's Principles and Practices of Infection Diseases] 6th Edition (2004) by Gerald L. Mandell MD, MACP, John E. Bennett MD, Raphael Dolin MD, ISBN 0-443-06643-4 · Hardback · 4016 Pages Churchill Livingstone </ref>- most of the times it is an underestimated cause of FUO but it is often important to consider it in people who worked in the medical field and majority of them are females.
 
=== Causes by Organ System===
 
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Endocarditis]], [[Deep vein thrombosis]], [[Thrombophlebitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| [[Bismuth]]
|-
 
|-bgcolor="LightSteelBlue"
 
| '''Dermatologic'''
 
|bgcolor="Beige"| No underlying causes
 
|-
 
|-bgcolor="LightSteelBlue"
 
| '''Drug Side Effect'''
 
|bgcolor="Beige"| [[Allopurinol]], [[Amphotericin B]], [[Aminoglutethimide]], [[Barbiturates]], [[Bismuth]], [[Chlorpromazine]], [[Docetaxel]], [[Ethotoin]], [[GMCSF]], [[Levomepromazine]], [[Methyldopa]], [[Perazine]], Phenophthalein, [[Pipothiazine]], [[Promazine]], [[Penicillin]], [[Phenytoin]], [[Quinidine]], [[Rifampicin]]


|-
===Classic FUO===


|-bgcolor="LightSteelBlue"
#Malignancies such as [[Hodgkin's lymphoma|Hodgkin]] and [[Non-Hodgkin lymphoma|non-Hodgkin]] lymphoma, [[Myeloproliferative neoplasm|myeloproliferative]] disorders, [[colorectal carcinoma]] and carcinoma of liver.
#Infections such as intrabdominal and pelvic [[abscesses]], inflammation of the endocardium, [[tuberculosis]], [[cat scratch disease]], [[CMV infection|CMV]] and [[Epstein Barr virus|EBV]] infections.
#Inflammatory causes such as autoimmune diseases ([[systemic lupus erythematosus]], [[Rheumatoid arthritis]]) and [[polymyalgia rheumatica]].<ref name="HayakawaRamasamy2012">{{cite journal|last1=Hayakawa|first1=Kayoko|last2=Ramasamy|first2=Balaji|last3=Chandrasekar|first3=Pranatharthi H.|title=Fever of Unknown Origin: An Evidence-Based Review|journal=The American Journal of the Medical Sciences|volume=344|issue=4|year=2012|pages=307–316|issn=00029629|doi=10.1097/MAJ.0b013e31824ae504}}</ref>
#Miscellaneous such as Medication/drug fever,Hyperthyroidism Hematoma,Chronic pulmonary.<ref name="pmid32462043">{{cite journal| author=Wright WF, Auwaerter PG| title=Fever and Fever of Unknown Origin: Review, Recent Advances, and Lingering Dogma. | journal=Open Forum Infect Dis | year= 2020 | volume= 7 | issue= 5 | pages= ofaa132 | pmid=32462043 | doi=10.1093/ofid/ofaa132 | pmc=7237822 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32462043  }} </ref>


| '''Ear Nose Throat'''
===Neutropenic FUO===
These are mostly caused by bacterial, fungal and viral infection because of the decreased neutrophil count.<ref name="HayakawaRamasamy20122">{{cite journal|last1=Hayakawa|first1=Kayoko|last2=Ramasamy|first2=Balaji|last3=Chandrasekar|first3=Pranatharthi H.|title=Fever of Unknown Origin: An Evidence-Based Review|journal=The American Journal of the Medical Sciences|volume=344|issue=4|year=2012|pages=307–316|issn=00029629|doi=10.1097/MAJ.0b013e31824ae504}}</ref>


|bgcolor="Beige"| Periodic fever aphthous [[pharyngitis]] and cervical adenopathy, [[Sinusitis]]
===HIV associated FUO===
This may due to acute infection from HIV itself earlier or later due to [[Opportunistic infection|opportunistic]] bacterial, fungal and viral infections such as [[mycobacteria]], [[Toxoplasmosis|toxoplasma]] etc.<ref name="HayakawaRamasamy20123">{{cite journal|last1=Hayakawa|first1=Kayoko|last2=Ramasamy|first2=Balaji|last3=Chandrasekar|first3=Pranatharthi H.|title=Fever of Unknown Origin: An Evidence-Based Review|journal=The American Journal of the Medical Sciences|volume=344|issue=4|year=2012|pages=307–316|issn=00029629|doi=10.1097/MAJ.0b013e31824ae504}}</ref>


|-
===Nosocomial FUO===
Causes of nosocomial FUO are related to hospital setting such as drugs, infections acquired during hospitalization and complications that occur during and after surgery.<ref name="pmid32462043">{{cite journal| author=Wright WF, Auwaerter PG| title=Fever and Fever of Unknown Origin: Review, Recent Advances, and Lingering Dogma. | journal=Open Forum Infect Dis | year= 2020 | volume= 7 | issue= 5 | pages= ofaa132 | pmid=32462043 | doi=10.1093/ofid/ofaa132 | pmc=7237822 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32462043  }}</ref>


|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"|  [[Cirrhosis of liver]], [[Crohn's disease]], [[Ulcerative Colitis]], [[Whipple's disease]], [[Choledochal cyst]], [[Cholangitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[Angioimmunoblastic lymphadenopathy with dysproteinaemia]], [[Hyperimmunoglobulinemia D and periodic fever syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Lung abscess]], Subdiaphragmatic [[abscess]], [[Liver abscess]], [[Pyelonephritis]], [[Salmonella typhi]], [[Osteomyelitis]], [[Gonorrhoea]], [[Leptospirosis]], [[Q fever]], [[Endocarditis]], [[Tularaemia]], [[Scrub typhus]], [[Relapsing fever]], [[Rickettsia]] akari, [[Boutonneuse fever]], [[Mycobacterium tuberculosis]], [[Yersinia enterocolitica]], Periodic fever aphthous [[pharyngitis]] and cervical adenopathy, [[Ehrlichiosis]], [[Atypical pneumonia]], [[Cyclical neutropenia]], [[Pyelonephritis classification|Xanthogranulomatous pyelonephritis]], [[Streptococcus suis]], Catheter infections, [[Lepromatous leprosy]], [[Treponema pallidum]], [[Neisseria meningiditis]], [[UTI]], [[Borrelia burgdorferi]], [[Mycobacterium kansasii]], [[Mycobacterium avium-intracellulare]], [[Sinusitis]], [[Actinomycosis]], [[Yersinia pseudotuberculosis]], [[Leptospira]] hebdomadis, [[Listeria monocytogenes]], [[Brucellosis]], [[Blastomycosis]], [[Candida albicans]], [[Allergic bronchopulmonary aspergillosis]], Invasive [[aspergillosis]], [[Cryptococcus neoformans]], [[Psittacosis]], [[Coccidioidomycosis]], [[Histoplasmosis]], [[Malaria]], [[Toxoplasma]], [[Sleeping sickness]], [[Entamoeba histolytica]], [[Visceral leishmaniasis]], [[Fasciola hepatica]], [[Epstein-Barr virus]], [[Hepatitis B]], [[HIV-1 disease]], [[Newcastle disease]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| [[Osteomyelitis]], [[Discitis]], [[Polymyalgia rheumatica]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| [[Hereditary sensory and autonomic neuropathy]] type 3, [[Vitamin B12 deficiency]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| [[Vitamin B12 deficiency]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[Renal adenocarcinoma]], [[Hodgkin's lymphoma]], [[Pancreatic cancer]], [[Angioimmunoblastic lymphadenopathy with dysproteinaemia]], [[Paraneoplastic syndrome]], [[Atrial myxoma]] 
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| Factitious fever
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| [[Lung abscess]], [[Allergic bronchopulmonary aspergillosis]], Invasive [[aspergillosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| [[Acute pyelonephritis]], [[Pyelonephritis classification|Xanthogranulomatous pyelonephritis]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| [[Polyarteritis nodosa]], [[Systemic lupus erythematosus]], [[Polymyalgia rheumatica]], [[Sarcoidosis]], [[Polymyositis]], [[Temporal arteritis]], [[Juvenile chronic arthritis]], [[Hyperimmunoglobulinemia D and periodic fever syndrome]], [[Wegener's granulomatosis]], [[Recurrent hereditary polyserositis]], [[Disseminated Intravascular Coagulation]], [[Still's Disease]], [[Rheumatoid disease]], [[Whipple's disease]], [[Retroperitoneal fibrosis]], [[Crohn's disease]], [[Ulcerative colitis]], [[Schnitzler syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| Surgery complication, [[Fabry's disease]]
|-
|}
===Causes by Alphabetical Order===
{{Columns-list|3|
*[[Actinomycosis]]
*[[Allergic bronchopulmonary aspergillosis]]
*[[Allopurinol]]
*[[Aminoglutethimide]]
*[[Amphotericin B]]
*[[Angioimmunoblastic lymphadenopathy with dysproteinaemia]]
*[[Atrial myxoma]]
*[[Atypical pneumonia]]
*[[Barbiturates]]
*[[Bismuth]]
*[[Blastomycosis]]
*[[Borrelia burgdorferi]]
*[[Boutonneuse fever]]
*[[Brucellosis]]
*[[Candida albicans]]
*Catheter infections
*[[Chlorpromazine]]
*[[Cholangitis]]
*[[Choledochal cyst]]
*[[Cirrhosis of liver]]
*[[Coccidioidomycosis]]
*[[Crohn's disease]]
*[[Cryptococcus neoformans]]
*[[Cyclical neutropenia]]
*[[Deep vein thrombosis]]
*[[Discitis]]
*[[Disseminated Intravascular Coagulation]]
*[[Docetaxel]]
*[[Ehrlichiosis]]
*[[Endocarditis]]
*[[Entamoeba histolytica]]
*[[Epstein-Barr virus]]
*[[Ethotoin]]
*[[Fabry's disease]]
*[[Fasciola hepatica]]
*[[GMCSF]]
*[[Gonorrhoea]]
*[[Hepatitis B]]
*[[Hereditary sensory and autonomic neuropathy]] type 3
*[[Histoplasmosis]]
*[[HIV-1 disease]]
*[[Hodgkin's lymphoma]]
*[[Hyperimmunoglobulinemia D and periodic fever syndrome]]
*Invasive [[aspergillosis]]<ref name="pmid23331746">{{cite journal |author=Méndez-Tovar LJ, Manzano-Gayosso P, Cumplido-Uribe C, Hernández-Hernández F, Ramos-Hernández J, López-Martínez R |title=[Invasive mycosis, immunocompromise and fever of unknown origin] |language=Spanish; Castilian |journal=Rev Med Inst Mex Seguro Soc |volume=50 |issue=6 |pages=609–14 |year=2012 |pmid=23331746 |doi= |url=}}</ref>
*[[Juvenile chronic arthritis]]
*[[Lepromatous leprosy]]
*[[Leptospira]] hebdomadis
*[[Leptospirosis]]
*[[Levomepromazine]]
*[[Listeria monocytogenes]]
*[[Liver abscess]]
*[[Lung abscess]]
*[[Lymphoma]]<ref name="pmid22989822">{{cite journal |author=Zhang J, Chen B, Xu X, ''et al.'' |title=Clinical features of 66 lymphoma patients presenting with a fever of unknown origin |journal=Intern. Med. |volume=51 |issue=18 |pages=2529–36 |year=2012 |pmid=22989822 |doi= |url=}}</ref>
*[[Malaria]]
*[[Methyldopa]]
*[[Mycobacterium avium-intracellulare]]
*[[Mycobacterium kansasii]]
*[[Mycobacterium tuberculosis]]
*[[Neisseria meningiditis]]
*[[Newcastle disease]]
*[[Osteomyelitis]]
*[[Pancreatic cancer]]
*[[Paraneoplastic syndrome]]
*[[Penicillin]]
*[[Perazine]]
*Periodic fever aphthous [[pharyngitis]] and cervical adenopathy
*Phenophthalein
*[[Phenytoin]]
*[[Pipothiazine]]
*[[Polyarteritis nodosa]]
*[[Polymyalgia rheumatica]]
*[[Polymyositis]]
*[[Promazine]]
*[[Psittacosis]]
*[[Pulmonary embolism]]
*[[Pyelonephritis]]
*[[Q fever]]<ref name="Granulomatous Hepatitis with Q fever">{{cite journal |author=Aguilar-Olivos N, Del Carmen Manzano-Robleda M, Gutiérrez-Grobe Y, Chablé-Montero F, Albores-Saavedra J, López-Méndez E |title=Granulomatous hepatitis caused by Q fever: a differential diagnosis of fever of unknown origin |journal=Ann Hepatol |volume=12 |issue=1 |pages=138–41 |year=2013 |month=January |pmid=23293205 |doi= |url=}}</ref>
*[[Quinidine]]
*[[Recurrent hereditary polyserositis]]
*[[Relapsing fever]]
*[[Renal adenocarcinoma]]<ref name="pmid22658892">{{cite journal |author=Chandrankunnel J, Cunha BA, Petelin A, Katz D |title=Fever of unknown origin (FUO) and a renal mass: renal cell carcinoma, renal tuberculosis, renal malakoplakia, or xanthogranulomatous pyelonephritis? |journal=Heart Lung |volume=41 |issue=6 |pages=606–9 |year=2012 |pmid=22658892 |doi=10.1016/j.hrtlng.2012.03.008 |url=}}</ref>
*[[Retroperitoneal fibrosis]]
*[[Rheumatoid disease]]
*[[Rickettsia]] akari
*[[Rifampicin]]
*[[Salmonella typhi]]
*[[Sarcoidosis]]
*[[Schnitzler syndrome]]
*[[Scrub typhus]]
*[[Sinusitis]]
*[[Sleeping sickness]]
*[[Still's Disease]]
*[[Streptococcus suis]]
*Subdiaphragmatic [[abscess]]
*Surgery complication
*[[Systemic lupus erythematosus]]<ref name="pmid22980227">{{cite journal |author=Petelin A, Johnson DH, Cunha BA |title=Fever of unknown origin (FUO) due to systemic lupus erythematosus (SLE) presenting as pericarditis |journal=Heart Lung |volume= |issue= |pages= |year=2012 |month=September |pmid=22980227 |doi=10.1016/j.hrtlng.2012.07.002 |url=}}</ref>
*[[Temporal arteritis]]
*[[Thrombophlebitis]]
*[[Toxoplasma]]
*[[Treponema pallidum]]
*[[Tularaemia]]
*[[Ulcerative colitis]]
*[[UTI]]
*[[Visceral leishmaniasis]]
*[[Vitamin B12 deficiency]]
*[[Wegener's granulomatosis]]
*[[Whipple's disease]]
*[[Pyelonephritis classification|Xanthogranulomatous pyelonephritis]]
*[[Yersinia enterocolitica]]
*[[Yersinia pseudotuberculosis]]
}}


==References==
==References==
{{Reflist|2}}


{{Reflist|2}}
[[Category:Ailments of unknown etiology]]
[[Category:Needs overview]]
[[Category:Disease]]
[[Category:Infectious disease]]

Latest revision as of 16:40, 26 January 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Naresh Mullaguri, M.B.B.S. [2]

Synonyms and keywords: febris continua e causa ignota; febris e causa ignota; febris E.C.I.; FUO; PUO; pyrexia of unknown origin

Overview

Classic FUO may be caused by infection, neoplasia, inflammatory , miscellaneous diseases, and undiagnosed illness.Common causes of neutropenic FUO include bacterial, fungal and viral infection.Causes of nosocomial FUO are related to hospital setting such as drugs, infections acquired during hospitalization and complications that occur during and after surgery.This may due to acute infection from HIV itself earlier or later due to opportunistic bacterial, fungal and viral infections such as mycobacteria, toxoplasma etc.


Causes

Etiology is different for different categories of FUO:

Classic FUO

  1. Malignancies such as Hodgkin and non-Hodgkin lymphoma, myeloproliferative disorders, colorectal carcinoma and carcinoma of liver.
  2. Infections such as intrabdominal and pelvic abscesses, inflammation of the endocardium, tuberculosis, cat scratch disease, CMV and EBV infections.
  3. Inflammatory causes such as autoimmune diseases (systemic lupus erythematosus, Rheumatoid arthritis) and polymyalgia rheumatica.[1]
  4. Miscellaneous such as Medication/drug fever,Hyperthyroidism Hematoma,Chronic pulmonary.[2]

Neutropenic FUO

These are mostly caused by bacterial, fungal and viral infection because of the decreased neutrophil count.[3]

HIV associated FUO

This may due to acute infection from HIV itself earlier or later due to opportunistic bacterial, fungal and viral infections such as mycobacteria, toxoplasma etc.[4]

Nosocomial FUO

Causes of nosocomial FUO are related to hospital setting such as drugs, infections acquired during hospitalization and complications that occur during and after surgery.[2]


References

  1. ↑ Hayakawa, Kayoko; Ramasamy, Balaji; Chandrasekar, Pranatharthi H. (2012). "Fever of Unknown Origin: An Evidence-Based Review". The American Journal of the Medical Sciences. 344 (4): 307–316. doi:10.1097/MAJ.0b013e31824ae504. ISSN 0002-9629.
  2. ↑ 2.0 2.1 Wright WF, Auwaerter PG (2020). "Fever and Fever of Unknown Origin: Review, Recent Advances, and Lingering Dogma". Open Forum Infect Dis. 7 (5): ofaa132. doi:10.1093/ofid/ofaa132. PMC 7237822 Check |pmc= value (help). PMID 32462043 Check |pmid= value (help).
  3. ↑ Hayakawa, Kayoko; Ramasamy, Balaji; Chandrasekar, Pranatharthi H. (2012). "Fever of Unknown Origin: An Evidence-Based Review". The American Journal of the Medical Sciences. 344 (4): 307–316. doi:10.1097/MAJ.0b013e31824ae504. ISSN 0002-9629.
  4. ↑ Hayakawa, Kayoko; Ramasamy, Balaji; Chandrasekar, Pranatharthi H. (2012). "Fever of Unknown Origin: An Evidence-Based Review". The American Journal of the Medical Sciences. 344 (4): 307–316. doi:10.1097/MAJ.0b013e31824ae504. ISSN 0002-9629.
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