Fever of unknown origin pathophysiology: 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]]
| style="vertical-align: middle; padding: 5px;" align="center" |[[File:Siren.gif|30px|link=Fever of unknown origin resident survival guide]]
| 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==
==Overview==
The exact pathogenesis of [disease name] is not fully understood.
The exact pathogenesis of FUO is not fully understood in many cases where the exact etiology is not known. However in cases where etiology is known its pathophysiology depends upon etiology.<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>


OR
<br />
 
[[Category: (name of the system)]]
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
 
OR
 
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
 
OR
 
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
 
OR
 
 
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
 
OR
 
The progression to [disease name] usually involves the [molecular pathway].
 
OR
 
The pathophysiology of [disease/malignancy] depends on the histological subtype.
 
 
==Pathophysiology==
 
===Classic FUO===
 
Classic FUO refers to the original classification by Petersdorf and Beeson. The outpatient setting has been included to reflect current medical practise.  The current definition requires three outpatient visits or three days in hospital or 1 week of "intelligent and invasive" ambulatory investigation.<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> Studies show there are five categories of conditions: [[infection]]s (i.e.  abscesses, [[endocarditis]], [[tuberculosis]], and complicated [[urinary tract infection]]s), [[neoplasm]]s (i.e. [[lymphoma]]s, [[leukaemia]]s), [[connective tissue disease]]s (i.e. [[temporal arteritis]] and [[polymyalgia rheumatica]], [[Still's disease]], [[systemic lupus erythematosus]], and [[rheumatoid arthritis]]), miscellaneous disorders (i.e.  [[alcoholic hepatitis]], [[granuloma]]tous conditions), and undiagnosed conditions.<ref name="Oxford"> [http://www.oup.com/us/catalog/general/subject/Medicine/PrimaryCare/?ci=0192629220&view=usa The Oxford Textbook of Medicine] Edited by David A. Warrell, Timothy M. Cox and John D. Firth with Edward J. Benz, Fourth Edition (2003), Oxford University Press, ISBN 0-19-262922-0</ref> The new definition is broader, stipulating three outpatient visits or 3 days in the hospital without elucidation of a cause or 1 week of "intelligent and invasive" ambulatory investigation.
 
===Nosocomial (health care-associated) FUO===
 
Nosocomial FUO refers to [[pyrexia]] in patients that have been admitted to hospital for at least 24 hours. This is commonly related to hospital associated factors such as, surgery, use of [[urinary catheter]], intravascular devices (i.e. "drip", [[pulmonary artery catheter]]), drugs (antibiotics induced ''[[Clostridium difficile]]'' colitis, and [[drug fever]]), immobilization (decubitus, thromboembolic event). [[Sinusitis]] in the [[intensive care unit]] is associated with nasogastric and orotracheal tubes.<ref name="Harrison"/><ref name="Oxford"/> Other conditions that should be considered are deep-vein thrombophlebitis, and [[pulmonary embolism]], [[transfusion reaction]]s, [[acalculous cholecystitis]], [[thyroiditis]], [[alcohol]]/[[drug withdrawal]], [[adrenal insufficiency]], [[pancreatitis]].<ref name="Harrison"/>
 
===Neutropenic (immune-deficient) FUO===
 
Immunodeficiency can be seen in patients receiving [[chemotherapy]] or in hematologic malignant neoplasms. Fever is concommittent with [[neutropenia]] ([[neutrophil]] <500/uL) or impaired cell-mediated immunity. The lack of immune response masks a potentially dangerous course. Infection is the most common cause.<ref name="Harrison"/><ref name="Oxford"/>
 
===Human immunodeficiency virus (HIV)-related FUO===
 
HIV-infected patients are a subgroup of the immunodeficient FUO, and frequently have fever. The primary phase shows fever since it has a [[mononucleosis]]-like illness. In advanced stages of infection fever mostly is the result of a superimposed illness.<ref name="Harrison"/><ref name="Oxford"/>


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


[[Category:Ailments of unknown etiology]]
[[Category:Ailments of unknown etiology]]

Latest revision as of 15:40, 25 January 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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

Overview

The exact pathogenesis of FUO is not fully understood in many cases where the exact etiology is not known. However in cases where etiology is known its pathophysiology depends upon etiology.[1]


References

  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).
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