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[[Category:Ailments of unknown etiology]] | [[Category:Ailments of unknown etiology]] | ||
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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
Chest radiograph should be considered as a part of the initial diagnostic workup.
Invasive techniques (biopsy and laparotomy for pathological and bacteriological examination) may be required to make a definitive diagnosis.[1][2][3]
Imaging Studies
Chest Radiograph
Chest radiograph should be considered as a part of the initial diagnostic workup.
Echocardiography
Echocardiography should be performed when suspecting endocarditis.
Abdominal Ultrasonography
Hepatobiliary pathology may be detected by abdominal ultrasonography.
Chest CT Scan
CT scan of the chest may detect nodular lesions (suggestive of malignancy, fungal, mycobacterial, or nocardial infection) and mediastinal adenopathy (suggestive of lymphoma, histoplasmosis, or sarcoidosis).
Abdominal CT Scan
An abdominal CT scan may show intra-abdominal abscess or malignancy of the visceral organs.
Positron Emission Tomography
Positron emission tomography has been reported to have a sensitivity of 84% and a specificity of 86% for localizing the nidus of fever of unknown origin.[4]
Other Diagnostic Studies
Lymph Node Biopsy
Lymph node biopsy may be useful when suspecting lymphoma, lymphogranuloma venereum, toxoplasmosis, and Kikuchi disease. Granulomas in lymph node biopsies may indicate a disorder associated with granulomatous inflammation (eg, tuberculosis, sarcoidosis) or lymphoma. The preferred lymph nodes to biopsy are the posterior cervical, epitrochlear, or supraclavicular nodes.[5][6]
Bone Marrow Biopsy
Bone marrow biopsy may be considered when suspecting intracellular infectious pathogens or hematologic malignancies.
Discontinuation of Nonessential Medications
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 empiric antibiotics. Therapeutic trials of antimicrobial agents may be considered if other techniques fail to disclose the cause of FUO.[1]
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.[7]
References
- ↑ 1.0 1.1 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
- ↑ 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.
- ↑ Pease, G. L. (1956-08). "Granulomatous lesions in bone marrow". Blood. 11 (8): 720–734. ISSN 0006-4971. PMID 13342072. Check date values in:
|date=(help) - ↑ Dorfman, R. F.; Remington, J. S. (1973-10-25). "Value of lymph-node biopsy in the diagnosis of acute acquired toxoplasmosis". The New England Journal of Medicine. 289 (17): 878–881. doi:10.1056/NEJM197310252891702. ISSN 0028-4793. PMID 4580783.
- ↑ 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)