Fever of unknown origin history and symptoms: Difference between revisions
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| style="vertical-align: middle; padding: 5px;" align=center | [[Fever of unknown origin resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] | | style="vertical-align: middle; padding: 5px;" align="center" |[[Fever of unknown origin resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] | ||
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==History== | ==History== | ||
History is the most important step in making diagnosis of FUO, most important components of history are listed below: | |||
=== History of presenting illness === | |||
Proper attention should made in documenting history of presenting illness which is mostly fever, duration of fever, pattern of fever, and associated symptoms may provide clues toward diagnosis and limit unnecessary investigations. | |||
=== Past medical and surgical history === | |||
Chronic medical illness such as tuberculosis, SLE and other autoinflammatory conditions should be inquired as they may be the source of fever. Surgical history is important as post operative complications can cause fever. | |||
=== Social History === | |||
Social history is very important because diseases like infective endocarditis and osteomyelitis are common in drug abuser, histoplasmosis is common in cave explorers, leptospirosis common in surfers, catch scratch disease and diseases caused by insects are common in people exposed to animals. Some diseases are endemic to certain places hence people should be inquired about their place of origin as all of the aforementioned diseases can be cause of FUO. | |||
=== Socioeconomic and Vaccination history === | |||
Some diseases are limited to poor population due to malnutrition, decreased immunity and living in overcrowded places which increases the chances of contact with the disease source. Unvaccinated people are prone to certain diseases that may cause FUO. | |||
=== Family history === | |||
Genetics play important role in acquiring and response to disease. | |||
<br /> | |||
==Symptoms== | ==Symptoms== | ||
===Fever patterns=== | ===Fever patterns=== | ||
* Sustained fever: the fluctuation in temperature during a 24-hour period is 0.3 °C (0.5 °F) or less. | |||
* Remittent fever: the temperature is elevated, and it falls each day, but not to normal, remaining 37.3 °C (99.2 °F) or above. The excursion in temperature is more than 0.3 °C (0.5 °F) and less than 1.4 °C (2.5 °F). | *Sustained fever: the fluctuation in temperature during a 24-hour period is 0.3 °C (0.5 °F) or less. | ||
* Intermittent fever: the temperature is elevated but falls to normal (37.2 °C [99 °F] or below) each day. The excursion in temperature is more than 0.3 °C (0.5 °F) and less than 1.4 °C (2.5 °F). | *Remittent fever: the temperature is elevated, and it falls each day, but not to normal, remaining 37.3 °C (99.2 °F) or above. The excursion in temperature is more than 0.3 °C (0.5 °F) and less than 1.4 °C (2.5 °F). | ||
* Hectic fever: remittent or intermittent fever, with a difference of 1.4 °C (2.5 °F) or more between peak and trough.<ref>{{Cite journal| issn = 0003-9926| volume = 139| issue = 11| pages = 1225–1228| last1 = Musher| first1 = D. M.| last2 = Fainstein| first2 = V.| last3 = Young| first3 = E. J.| last4 = Pruett| first4 = T. L.| title = Fever patterns. Their lack of clinical significance| journal = Archives of Internal Medicine| date = 1979-11| pmid = 574377}}</ref> | *Intermittent fever: the temperature is elevated but falls to normal (37.2 °C [99 °F] or below) each day. The excursion in temperature is more than 0.3 °C (0.5 °F) and less than 1.4 °C (2.5 °F). | ||
*Hectic fever: remittent or intermittent fever, with a difference of 1.4 °C (2.5 °F) or more between peak and trough.<ref>{{Cite journal| issn = 0003-9926| volume = 139| issue = 11| pages = 1225–1228| last1 = Musher| first1 = D. M.| last2 = Fainstein| first2 = V.| last3 = Young| first3 = E. J.| last4 = Pruett| first4 = T. L.| title = Fever patterns. Their lack of clinical significance| journal = Archives of Internal Medicine| date = 1979-11| pmid = 574377}}</ref> | |||
===Fever patterns and their clinical significance=== | ===Fever patterns and their clinical significance=== | ||
The periodicity of fever generally offers little diagnostic value in ascertaining the etiology of fever. Characteristic fever patterns include:<ref>{{cite book | last = Isaac | first = Benedict | title = Unexplained fever : a guide to the diagnosis and management of febrile states in medicine, surgery, pediatrics, and subspecialties | publisher = CRC Press | location = Boca Raton | year = 1991 | isbn = 9780849345562 }}</ref> | The periodicity of fever generally offers little diagnostic value in ascertaining the etiology of fever. Characteristic fever patterns include:<ref>{{cite book | last = Isaac | first = Benedict | title = Unexplained fever : a guide to the diagnosis and management of febrile states in medicine, surgery, pediatrics, and subspecialties | publisher = CRC Press | location = Boca Raton | year = 1991 | isbn = 9780849345562 }}</ref> | ||
* Sustained fever (suggestive of [[brucellosis]], [[drug fever]], [[lobar pneumonia]], [[tularemia]], [[typhoid]], [[typhus]]) | |||
* Remittent fever (suggestive of [[tuberculosis]], [[mycoplasma pneumonia]], [[malaria]], [[legionellosis]]) | *Sustained fever (suggestive of [[brucellosis]], [[drug fever]], [[lobar pneumonia]], [[tularemia]], [[typhoid]], [[typhus]]) | ||
* Intermittent fever (suggestive of [[malaria]], [[Visceral leishmaniasis|kala-azar]], [[pyaemia]]) | *Remittent fever (suggestive of [[tuberculosis]], [[mycoplasma pneumonia]], [[malaria]], [[legionellosis]]) | ||
:* Double quotidian fever (suggestive of [[Still's disease]], [[legionellosis]], [[miliary tuberculosis]], [[kala-azar]]) | *Intermittent fever (suggestive of [[malaria]], [[Visceral leishmaniasis|kala-azar]], [[pyaemia]]) | ||
:* Quotidian fever (suggestive of ''[[Plasmodium falciparum]]'' or ''[[Plasmodium knowlesi]]'' [[malaria]]) | |||
:* Tertian fever (suggestive of ''[[Plasmodium vivax]]'' or ''[[Plasmodium ovale]]'' [[malaria]]) | :*Double quotidian fever (suggestive of [[Still's disease]], [[legionellosis]], [[miliary tuberculosis]], [[kala-azar]]) | ||
:* Quartan fever (suggestive of ''[[Plasmodium malariae]]'' [[malaria]]) | :*Quotidian fever (suggestive of ''[[Plasmodium falciparum]]'' or ''[[Plasmodium knowlesi]]'' [[malaria]]) | ||
:* Alternate-day fever (suggestive of response to [[antipyretic]] [[dosage|dosage schedule]]) | :*Tertian fever (suggestive of ''[[Plasmodium vivax]]'' or ''[[Plasmodium ovale]]'' [[malaria]]) | ||
* Hyperpyrexia (suggestive of [[intracranial hemorrhage]], [[septicemia]], [[Kawasaki disease]], [[thyroid storm]], [[drug fever]]) | :*Quartan fever (suggestive of ''[[Plasmodium malariae]]'' [[malaria]]) | ||
* Hectic or spiking pattern (suggestive of [[biliary tract|biliary]] or [[urinary tract infection]], [[endocarditis]]) | :*Alternate-day fever (suggestive of response to [[antipyretic]] [[dosage|dosage schedule]]) | ||
* Morning temperature spikes (suggestive of [[typhoid fever]], [[tuberculosis]], [[polyarteritis nodosa]]) | |||
* Relapsing pattern (suggestive of ''[[relapsing fever|Borrelia recurrentis]]'', [[typhoid fever]], [[malaria]], [[brucellosis]], [[rat-bite fever]]) | *Hyperpyrexia (suggestive of [[intracranial hemorrhage]], [[septicemia]], [[Kawasaki disease]], [[thyroid storm]], [[drug fever]]) | ||
* Irregular pattern (suggestive of [[fever|factitious fever]]) | *Hectic or spiking pattern (suggestive of [[biliary tract|biliary]] or [[urinary tract infection]], [[endocarditis]]) | ||
* Pel-Ebstein pattern (suggestive of [[Hodgkin's lymphoma]]) | *Morning temperature spikes (suggestive of [[typhoid fever]], [[tuberculosis]], [[polyarteritis nodosa]]) | ||
* Picket fence pattern (suggestive of [[mastoiditis|acute mastoiditis]] complicated by [[transverse sinus]] [[thrombosis]]) | *Relapsing pattern (suggestive of ''[[relapsing fever|Borrelia recurrentis]]'', [[typhoid fever]], [[malaria]], [[brucellosis]], [[rat-bite fever]]) | ||
* Saddleback pattern (suggestive of [[dengue fever]], [[leptospirosis]], [[poliomyelitis]], [[human granulocytic ehrlichiosis]]) | *Irregular pattern (suggestive of [[fever|factitious fever]]) | ||
* Wunderlich curve pattern (suggestive of [[typhoid fever]]) | *Pel-Ebstein pattern (suggestive of [[Hodgkin's lymphoma]]) | ||
*Picket fence pattern (suggestive of [[mastoiditis|acute mastoiditis]] complicated by [[transverse sinus]] [[thrombosis]]) | |||
*Saddleback pattern (suggestive of [[dengue fever]], [[leptospirosis]], [[poliomyelitis]], [[human granulocytic ehrlichiosis]]) | |||
*Wunderlich curve pattern (suggestive of [[typhoid fever]]) | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Ailments of unknown etiology]] | [[Category:Ailments of unknown etiology]] | ||
Revision as of 22:47, 23 January 2021
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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
History
History is the most important step in making diagnosis of FUO, most important components of history are listed below:
History of presenting illness
Proper attention should made in documenting history of presenting illness which is mostly fever, duration of fever, pattern of fever, and associated symptoms may provide clues toward diagnosis and limit unnecessary investigations.
Past medical and surgical history
Chronic medical illness such as tuberculosis, SLE and other autoinflammatory conditions should be inquired as they may be the source of fever. Surgical history is important as post operative complications can cause fever.
Social History
Social history is very important because diseases like infective endocarditis and osteomyelitis are common in drug abuser, histoplasmosis is common in cave explorers, leptospirosis common in surfers, catch scratch disease and diseases caused by insects are common in people exposed to animals. Some diseases are endemic to certain places hence people should be inquired about their place of origin as all of the aforementioned diseases can be cause of FUO.
Socioeconomic and Vaccination history
Some diseases are limited to poor population due to malnutrition, decreased immunity and living in overcrowded places which increases the chances of contact with the disease source. Unvaccinated people are prone to certain diseases that may cause FUO.
Family history
Genetics play important role in acquiring and response to disease.
Symptoms
Fever patterns
- Sustained fever: the fluctuation in temperature during a 24-hour period is 0.3 °C (0.5 °F) or less.
- Remittent fever: the temperature is elevated, and it falls each day, but not to normal, remaining 37.3 °C (99.2 °F) or above. The excursion in temperature is more than 0.3 °C (0.5 °F) and less than 1.4 °C (2.5 °F).
- Intermittent fever: the temperature is elevated but falls to normal (37.2 °C [99 °F] or below) each day. The excursion in temperature is more than 0.3 °C (0.5 °F) and less than 1.4 °C (2.5 °F).
- Hectic fever: remittent or intermittent fever, with a difference of 1.4 °C (2.5 °F) or more between peak and trough.[1]
Fever patterns and their clinical significance
The periodicity of fever generally offers little diagnostic value in ascertaining the etiology of fever. Characteristic fever patterns include:[2]
- Sustained fever (suggestive of brucellosis, drug fever, lobar pneumonia, tularemia, typhoid, typhus)
- Remittent fever (suggestive of tuberculosis, mycoplasma pneumonia, malaria, legionellosis)
- Intermittent fever (suggestive of malaria, kala-azar, pyaemia)
- Double quotidian fever (suggestive of Still's disease, legionellosis, miliary tuberculosis, kala-azar)
- Quotidian fever (suggestive of Plasmodium falciparum or Plasmodium knowlesi malaria)
- Tertian fever (suggestive of Plasmodium vivax or Plasmodium ovale malaria)
- Quartan fever (suggestive of Plasmodium malariae malaria)
- Alternate-day fever (suggestive of response to antipyretic dosage schedule)
- Hyperpyrexia (suggestive of intracranial hemorrhage, septicemia, Kawasaki disease, thyroid storm, drug fever)
- Hectic or spiking pattern (suggestive of biliary or urinary tract infection, endocarditis)
- Morning temperature spikes (suggestive of typhoid fever, tuberculosis, polyarteritis nodosa)
- Relapsing pattern (suggestive of Borrelia recurrentis, typhoid fever, malaria, brucellosis, rat-bite fever)
- Irregular pattern (suggestive of factitious fever)
- Pel-Ebstein pattern (suggestive of Hodgkin's lymphoma)
- Picket fence pattern (suggestive of acute mastoiditis complicated by transverse sinus thrombosis)
- Saddleback pattern (suggestive of dengue fever, leptospirosis, poliomyelitis, human granulocytic ehrlichiosis)
- Wunderlich curve pattern (suggestive of typhoid fever)
References
- ↑ Musher, D. M.; Fainstein, V.; Young, E. J.; Pruett, T. L. (1979-11). "Fever patterns. Their lack of clinical significance". Archives of Internal Medicine. 139 (11): 1225–1228. ISSN 0003-9926. PMID 574377. Check date values in:
|date=(help) - ↑ Isaac, Benedict (1991). Unexplained fever : a guide to the diagnosis and management of febrile states in medicine, surgery, pediatrics, and subspecialties. Boca Raton: CRC Press. ISBN 9780849345562.