Fever of unknown origin causes: Difference between revisions

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{{Fever of unknown origin}}
{{Fever of unknown origin}}
{{CMG}}
{{CMG}}; {{AE}} [[User:Naresh Mullaguri|Naresh Mullaguri, M.B.B.S.]] [mailto:mullaguri.nari@gmail.com]
 
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{{SK}} febris continua e causa ignota; febris e causa ignota; febris E.C.I.; FUO; PUO; pyrexia of unknown origin
==Overview==
==Overview==
==Causes==
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.
Extrapulmonary tuberculosis is the most frequent cause of FUO.<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>
Drug fever, as sole symptom of an adverse reaction to medication, should always be thought of. Disseminated granulomatoses such as [[Tuberculosis]], [[Histoplasmosis]], [[Coccidioidomycosis]], [[Blastomycosis]] and [[Sarcoidosis]] are associated with FUO.  


[[Lymphoma]]s are the most common cause of FUO in adults. Thromboembolic disease (i.e. [[pulmonary embolism]], [[deep venous thrombosis]]) occasionally shows [[fever]]. Although infrequent, its potentially lethal consequences warrant evaluation of this cause. [[Endocarditis]], although uncommon, is another important thing to consider. An underestimated reason is factitious [[fever]]. Patients frequently are women that work, or have worked, in the medical field and have complex [[medical history|medical histories]].<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>


=== Causes by Organ System===
==Causes==
 
Etiology is different for different categories of FUO:
 
 
{|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]]
 
|-
 
|-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]], [[Ethotoin]], [[GMCSF]], [[Levomepromazine]], [[Methyldopa]], [[Perazine]], [[Phenophthalein]], [[Pipothiazine]], [[Promazine]], [[Penicillin]], [[Phenytoin]], [[Quinidine]], [[Rifampicin]]
 
 
 
 
 
|-
 
|-bgcolor="LightSteelBlue"
 
| '''Ear Nose Throat'''
 
|bgcolor="Beige"|
 
|-
 
|-bgcolor="LightSteelBlue"
 
| '''Endocrine'''
 
|bgcolor="Beige"|
 
|-
 
|-bgcolor="LightSteelBlue"
 
| '''Environmental'''
 
|bgcolor="Beige"| No underlying causes
 
|-
 
|-bgcolor="LightSteelBlue"
 
| '''Gastroenterologic'''
 
|bgcolor="Beige"|
 
|-
 
 
 
|-bgcolor="LightSteelBlue"


| '''Genetic'''
===Classic FUO===


|bgcolor="Beige"|  
#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>


|-
===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="LightSteelBlue"
===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>


| '''Hematologic'''
===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="Beige"|
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Lung abscess]], [[Subdiaphragmatic abscess]], [[Liver abscess]], [[Pyelonephritis]], [[Salmonella typhi]], [[Osteomyelitis]], [[Neisseria 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]], [[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"|
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"|
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"|
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"|
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"|
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"|
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"|
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"|
|-
|-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"|
|-
|}


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


{{Reflist|2}}
[[Category:Ailments of unknown etiology]]
[[Category:Needs content]]
[[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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