Fever of unknown origin pathophysiology: Difference between revisions

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| 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}}
{{CMG}}
{{CMG}}


{{SK}} febris continua e causa ignota; febris e causa ignota; febris E.C.I.; FUO; PUO; pyrexia of unknown origin
==Overview==
==Overview==
In 1961 Petersdorf and Beeson suggested the following criteria:<ref name="Mandell"/><ref name="Harrison"/>
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>
* Fever higher than 38.3°C (101°F) on several occasions
* Persisting without diagnosis for at least 3 weeks
* At least 1 week's investigation in hospital
 
==Pathophysiology==
Presently FUO cases are codified in four subclasses.
 
*'''Classic FUO'''
 
This 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"/> 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="Mandell"/><ref name="Oxford"/>
 
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 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="Mandell"/><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"/>
 
*'''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="Mandell"/><ref name="Harrison"/><ref name="Oxford"/>
 
*'''Human immunodeficiency virus (HIV)-associated 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="Mandell"/><ref name="Harrison"/><ref name="Oxford"/>
<br />
{{see|Human immunodeficiency virus}}
[[Category: (name of the system)]]


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


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

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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