Fever of unknown origin resident survival guide: Difference between revisions

Fever of unknown origin; Resident Survival Guide
Diagnostic Criteria
Causes
Complete Diagnostic Approach
Empiric Therapy
Dos
Don'ts

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Revision as of 17:16, 19 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.; fever of obscured origin; fever of undetermined origin; FUO; PUO; pyrexia of unknown origin

Diagnostic Criteria

‘’’Fever of unknown origin’’’ may be considered providing all the following criteria are fulfilled:

Fever higher than 38.3°C (100.9°F) on several occasions
Persisting without diagnosis for at least 3 weeks
At least 1 week's investigation in hospital

Causes

Major causes of fever of unknown origin are as follows:^[1]

Infections

Localized

– Endocarditis

– Intra-abdominal infections

– Urinary tract infections

– Osteomyelitis

– Upper respiratory tract infections

– Infected peripheral vessels

Generalized

– Bacterial

– Mycobacterial

– Fungal

– Viral

– Parasitic

Neoplasia

– Lymphoproliferative disorders

– Leukemia

– Myelodysplastic syndrome

– Solid tumors

Rheumatic disorders

– Adult onset Still's disease

– Giant cell arteritis

– Polymyalgia rheumatica

– Other forms of vasculitis (e.g., polyarteritis nodosa, Wegener's granulomatosis, Takayasu's arteritis)

– Other rheumatologic disorders (e.g., systemic lupus erythematosus, rheumatoid arthritis, Sjogren's syndrome)

Endocrine disorders

– Hyperthyroidism

– Thyroiditis

– Adrenocortical insufficiency

Hereditary disorders (e.g., familial Mediterranean fever)
Factitious fever
Miscellaneous

– Granulomatous disorders

– Hepatitis

– Vascular disorders (e.g., pulmonary embolism, hematoma)

– Drug fever

Complete Diagnostic Approach

Abbreviations: CBC, complete blood count; CI, cardiac index; CK-MB, creatine kinase MB isoform; CVP, central venous pressure; DC, differential count; ICU, intensive care unit; INR, international normalized ratio; LFT, liver function test; MAP, mean arterial pressure; PCWP, pulmonary capillary wedge pressure; PT, prothrombin time; PTT, partial prothrombin time; SaO2, arterial oxygen saturation; SBP, systolic blood pressure; ScvO2, central venous oxygen saturation; SvO2, mixed venous oxygen saturation; SMA-7, sequential multiple analysis-7.

Suspected FUO

Empiric Antibiotic Therapy

Dos

Don'ts

References

↑ Hirschmann, J. V. (1997-03). "Fever of unknown origin in adults". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 24 (3): 291–300, quiz 301-302. ISSN 1058-4838. PMID 9114175. Check date values in: |date= (help)

[1] Hirschmann, J. V. (1997-03). "Fever of unknown origin in adults". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 24 (3): 291–300, quiz 301-302. ISSN 1058-4838. PMID 9114175. Check date values in: |date= (help)

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 ==Diagnostic Criteria==
-In 1961, Petersdorf and Beeson suggested the following criteria:<ref name="Mandell">
+‘’’Fever of unknown origin’’’ may be considered providing all the following criteria are fulfilled:
-[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><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>
 * Fever higher than 38.3°C (100.9°F) on several occasions
 * Persisting without diagnosis for at least 3 weeks
 * At least 1 week's investigation in hospital
-==Classification==
-In 1991, Durack and Street proposed a revised definition in which cases of FUO are categorized into four subclasses: classic FUO, nosocomial (health care-associated) FUO, neutropenic (immune-deficient) FUO, and HIV-related FUO.<ref>{{Cite journal| issn = 0195-3842| volume = 11| pages = 35–51| last1 = Durack| first1 = D. T.| last2 = Street| first2 = A. C.| title = Fever of unknown origin--reexamined and redefined| journal = Current Clinical Topics in Infectious Diseases| date = 1991| pmid = 1651090}}</ref>
-===Classic FUO===
-Fever (>38.3° C or >100.9° F) for >3 weeks with no identified cause after 3 days of hospital evaluation or ≥3 outpatient visits
-===Nosocomial (health care-associated) FUO===
-Fever (>38.3° C or >100.9° F) in hospitalized patients receiving acute care and with no infection present or incubating on admission if the diagnosis remains uncertain after 3 days of appropriate evaluation
-===Neutropenic (immune-deficient) FUO===
-Fever (>38.3° C or >100.9° F) in patients with neutropenia (absolute neutrophil count ≤500 per mm<sup>3</sup>) or immunodeficiencies if the diagnosis remains uncertain after 3 days of appropriate evaluation, including negative cultures after 48 hours
-===HIV-related FUO===
-Fever (>38.3° C or >100.9° F) for >3 weeks in outpatients with confirmed HIV infection or >3 days in inpatients with confirmed HIV infection if the diagnosis remains uncertain after appropriate evaluation
 ==Causes==