Fever of unknown origin pathophysiology: Difference between revisions

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Revision as of 19:25, 18 March 2015

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

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.^[1] Studies show there are five categories of conditions: infections (i.e. abscesses, endocarditis, tuberculosis, and complicated urinary tract infections), neoplasms (i.e. lymphomas, leukaemias), connective tissue diseases (i.e. temporal arteritis and polymyalgia rheumatica, Still's disease, systemic lupus erythematosus, and rheumatoid arthritis), miscellaneous disorders (i.e. alcoholic hepatitis, granulomatous conditions), and undiagnosed conditions.^[2]^[3] 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.^[2]^[1]^[3] Other conditions that should be considered are deep-vein thrombophlebitis, and pulmonary embolism, transfusion reactions, acalculous cholecystitis, thyroiditis, alcohol/drug withdrawal, adrenal insufficiency, pancreatitis.^[1]

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.^[2]^[1]^[3]

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.^[2]^[1]^[3]

References

↑ ^1.0 ^1.1 ^1.2 ^1.3 ^1.4 Harrison's Principles of Internal Medicine 16th Edition, The McGraw-Hill Companies, ISBN 0-07-140235-7
↑ ^2.0 ^2.1 ^2.2 ^2.3
↑ ^3.0 ^3.1 ^3.2 ^3.3 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

[Harrison-1] 1.0 ^1.1 ^1.2 ^1.3 ^1.4 Harrison's Principles of Internal Medicine 16th Edition, The McGraw-Hill Companies, ISBN 0-07-140235-7

[Mandell-2] 2.0 ^2.1 ^2.2 ^2.3

[Oxford-3] 3.0 ^3.1 ^3.2 ^3.3 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

[1]

[2]

[3]

@@ Line 10: / Line 10: @@
 ==Pathophysiology==
-Presently FUO cases are codified in four subclasses.
-*'''Classic FUO'''
+===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">[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="Mandell"/><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>
+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="Mandell"/><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.
-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'''
 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'''
+===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="Mandell"/><ref name="Harrison"/><ref name="Oxford"/>
-*'''Human immunodeficiency virus (HIV)-associated FUO'''
+===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="Mandell"/><ref name="Harrison"/><ref name="Oxford"/>
-{{see|Human immunodeficiency virus}}
 ==References==
+{{Reflist|2}}
-{{Reflist|2}}
 [[Category:Disease]]
 [[Category:Infectious disease]]