Fever of unknown origin other diagnostic studies: Difference between revisions
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===Naproxen test=== | ===Naproxen test=== | ||
[[Naproxen]] test can be used to distinguish neoplastic fever from other etiologies of FUO. | |||
At a dosage of 375 mg twice daily, [[naproxen]] demonstrated no antipyretic activity against fever in patients with occult infection. Defervescence within 12 hours occurs in almost all patients with neoplastic fever. The [[naproxen]] test is considered positive when there is a rapid or sustained abatement of fever during the 3 days of the trial period. Fever recurs after discontinuation of [[naproxen]] in patients with neoplasms.<ref>{{Cite journal| issn = 0147-9563| volume = 16| issue = 2| pages = 122–127| last = Chang| first = J. C.| title = How to differentiate neoplastic fever from infectious fever in patients with cancer: usefulness of the naproxen test| journal = Heart & Lung: The Journal of Critical Care| date = 1987-03| pmid = 3028981}}</ref> | At a dosage of 375 mg twice daily, [[naproxen]] demonstrated no antipyretic activity against fever in patients with occult infection. Defervescence within 12 hours occurs in almost all patients with neoplastic fever. The [[naproxen]] test is considered positive when there is a rapid or sustained abatement of fever during the 3 days of the trial period. Fever recurs after discontinuation of [[naproxen]] in patients with neoplasms.<ref>{{Cite journal| issn = 0147-9563| volume = 16| issue = 2| pages = 122–127| last = Chang| first = J. C.| title = How to differentiate neoplastic fever from infectious fever in patients with cancer: usefulness of the naproxen test| journal = Heart & Lung: The Journal of Critical Care| date = 1987-03| pmid = 3028981}}</ref> | ||
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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.; fever/pyrexia of obscured/undetermined/uncertain/unidentifiable/unknown focus/origin/source; fever/pyrexia without a focus/origin/source; FUO; PUO
Imaging Studies
Echocardiography should be performed when suspecting endocarditis.
Hepatobiliary pathology may be detected by abdominal ultrasonography. An abdominal CT scan may show infection or malignancy of the visceral organs.
Positron emission tomography using radioactively labelled fluorodeoxyglucose (FDG) has been reported to have a sensitivity of 84% and a specificity of 86% for localizing the nidus of fever of unknown origin.[1]
Other Diagnostic Studies
Tissue Biopsy
Invasive techniques (biopsy and laparotomy for pathological and bacteriological examination) may be required to make a definitive diagnosis.[2][3][4]
Suspected Drug Fever
A thorough review of drug history is mandatory. Nonessential medications should be discontinued.
Defervescence in less than 72 hours after discontinuing the culprit medication suggests drug fever. Rechallenge with the offending agent usually results in recurrence of drug fever.
Trial of Empiric Antibiotics
An infectious etiology is likely if abatement of fever occurs after the administration of antibiotics. Therapeutic trials of antimicrobial agents may be considered if other techniques fail to disclose the cause of FUO.[2]
Naproxen test
Naproxen test can be used to distinguish neoplastic fever from other etiologies of FUO.
At a dosage of 375 mg twice daily, naproxen demonstrated no antipyretic activity against fever in patients with occult infection. Defervescence within 12 hours occurs in almost all patients with neoplastic fever. The naproxen test is considered positive when there is a rapid or sustained abatement of fever during the 3 days of the trial period. Fever recurs after discontinuation of naproxen in patients with neoplasms.[5]
References
- ↑ Meller J, Altenvoerde G, Munzel U, Jauho A, Behe M, Gratz S, Luig H, Becker W (2000). "Fever of unknown origin: prospective comparison of [18F]FDG imaging with a double-head coincidence camera and gallium-67 citrate SPET". Eur J Nucl Med. 27 (11): 1617–25. PMID 11105817.
- ↑ 2.0 2.1 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
- ↑ Harrison's Principles of Internal Medicine 16th Edition, The McGraw-Hill Companies, ISBN 0-07-140235-7
- ↑ 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
- ↑ Chang, J. C. (1987-03). "How to differentiate neoplastic fever from infectious fever in patients with cancer: usefulness of the naproxen test". Heart & Lung: The Journal of Critical Care. 16 (2): 122–127. ISSN 0147-9563. PMID 3028981. Check date values in:
|date=(help)