Fever of unknown origin medical therapy: Difference between revisions
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{ | {{Siren|Fever of unknown origin}} | ||
{{Fever of unknown origin}} | {{Fever of unknown origin}} | ||
{{CMG}} | {{CMG}} | ||
{{SK}} febris continua e causa ignota; febris e causa ignota; febris E.C.I.; | {{SK}} 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 | ||
==Overview== | |||
Management of fever of unknown origin (FUO) should generally be withheld until the etiology of the fever has been determined, so that treatment can be directed against a specific pathology. However, empiric corticosteroids may be appropriate in patients with suspected temporal arteritis to prevent vascular complications. | |||
Patients with febrile neutropenia should receive broad-spectrum antipseudomonal antibiotics immediately after specimens for cultures have been obtained. | |||
==Medical Therapy== | ==Medical Therapy== | ||
Unless the patient is acutely ill, no therapy should be | Unless the patient is acutely ill, no therapy should be initiated before the cause has been determined. In the majority of classic FUO, non-specific therapy is ineffective and delays diagnosis. | ||
===Febrile Neutropenia=== | |||
{{Seealso|Febrile neutropenia medical therapy}} | |||
Exception may be made for neutropenic patients in which delayed treatment could lead to serious complications. | |||
After samples for cultures are obtained, febrile neutropenia should be aggressively treated with broad-spectrum antipseudomonal antibiotics. The antimicrobial regimen should be modified in accordance with the culture results.<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><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><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> | |||
===HIV/AIDS patients=== | |||
HIV-infected persons with pyrexia and [[hypoxia (medical)|hypoxia]], should be placed on therapy for [[Pneumocystis pneumonia|''Pneumocystis jirovecii'' infection]] and adjusted once the diagnosis is confirmed.<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> | |||
===Giant Cell Arteritis=== | |||
Empiric [[corticosteroids]] may be considered in patients with suspected [[giant cell arteritis]] to prevent vascular complications such as [[stroke]] and [[blindness]]. Giant cell arteritis should be suspected in a patient over the age of 50 with the following symptoms: | |||
* Newly onset [[headaches]] | |||
* Abrupt onset of [[blurry vision]] | |||
* Symptoms of [[polymyalgia rheumatica]] | |||
* [[Jaw claudication]] | |||
* Unexplained [[anemia]] | |||
* Elevated [[ESR|erythrocyte sedimentation rate (ESR)]] and/or [[CRP|C-reactive protein (CRP)]] | |||
==References== | ==References== | ||
Revision as of 00:00, 4 April 2015
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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
Overview
Management of fever of unknown origin (FUO) should generally be withheld until the etiology of the fever has been determined, so that treatment can be directed against a specific pathology. However, empiric corticosteroids may be appropriate in patients with suspected temporal arteritis to prevent vascular complications.
Patients with febrile neutropenia should receive broad-spectrum antipseudomonal antibiotics immediately after specimens for cultures have been obtained.
Medical Therapy
Unless the patient is acutely ill, no therapy should be initiated before the cause has been determined. In the majority of classic FUO, non-specific therapy is ineffective and delays diagnosis.
Febrile Neutropenia
Exception may be made for neutropenic patients in which delayed treatment could lead to serious complications.
After samples for cultures are obtained, febrile neutropenia should be aggressively treated with broad-spectrum antipseudomonal antibiotics. The antimicrobial regimen should be modified in accordance with the culture results.[1][2][3]
HIV/AIDS patients
HIV-infected persons with pyrexia and hypoxia, should be placed on therapy for Pneumocystis jirovecii infection and adjusted once the diagnosis is confirmed.[3]
Giant Cell Arteritis
Empiric corticosteroids may be considered in patients with suspected giant cell arteritis to prevent vascular complications such as stroke and blindness. Giant cell arteritis should be suspected in a patient over the age of 50 with the following symptoms:
- Newly onset headaches
- Abrupt onset of blurry vision
- Symptoms of polymyalgia rheumatica
- Jaw claudication
- Unexplained anemia
- Elevated erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP)
References
- ↑ 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
- ↑ 3.0 3.1 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