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fever of unknown origin

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fever of unknown origin is defined as
1) Fever >38.3*C (101*F) on atleast 2 occasions
2) illness duration more than 3 weeks
3) No known immunocompromised state
4) Uncertain diagnosis despite one week of inpatient evaluation

fever of unknown origin is defined as
1) Fever >38.3*C (101*F) on atleast 2 occasions
2) illness duration more than 3 weeks
3) No known immunocompromised state
4) Uncertain diagnosis despite one week of inpatient evaluation

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fever of unknown origin

  1. 1. Pyrexia of Unknown Origin - Dr. Akif A.B
  2. 2. -Fever >38.3*C (101*F) on atleast 2 occasions - illness duration more than 3 weeks -No known immunocompromised state -Uncertain diagnosis despite one week of inpatient evaluation
  3. 3. Uncertain diagnosis despite one week of inpatient evaluation Should include: History and clinical examination Complete blood count Liver function test Renal function test Chest x ray Ultrasound abdomen ANA, CK, Ferritin, RA factor Protein electrophoresis Blood and urine cultures - If all these tests doesn’t lead a doctor to a diagnosis, then it is labelled as PUO
  4. 4. ETIOLOGY 1) Infections - most common 2) Malignancy 3) Autoimmune/ Connective tissue disorders 4) Other causes In up to 20% of cases, cause of fever will not be identified despite thorough workup Temporal arteritis accounts for 16-17% of all causes of FUO in the elderly
  5. 5. INFECTIONS -Most common infectious causes are: Tuberculosis Intrabdominal and pelvic Abscesses -FUO in immunocompromised patients is often very difficult to diagnose -Previously HIV was one of the most common cause but now its been routinely tested
  6. 6. The most common malignancies are Hodgkin disease and non-Hodgkin lymphoma. MALIGNANCY Diagnosis of malignancy or autoimmune disorders becomes more likely as the duration of the fever increases.
  7. 7. Urgent Considerations In PUO Immunocompromised patients Giant cell arteritis suspect Should be empirically treated with broad spectrum antibiotics till the time we get a specific diagnosis Should be treated with Corticosteroids since if not treated early may lead to blindness.
  8. 8. Work up
  9. 9. - PDCs : Potentially Diagnostic Clues (Symptoms, signs and clues directing toward one diagnosis)
  10. 10. History Past medical history Known malignancy (recent chemotherapy, recent neutrophil count) Previously treated diseases such as endocarditis, tuberculosis, rheumatic fever Comorbid conditions (eg. diabetes) Past surgical history Type and date of surgery performed Postoperative complications Any indwelling foreign material A history of calf swelling, pain, or redness is suggestive of DVT.
  11. 11. Medication history Full list of medications Include over-the-counter and herbal remedies Social history Recent travel history Sexual history including enquiring about sexual practices Recreational drug use Hobbies including exposure to pets/animals Employment history including exposures Unusual dietary habits eg. consumption of unpasteurised dairy products or rare meats History
  12. 12. Skin and nail bed exam for clubbing, nodules, lesions, rashes Temporal artery palpation Gums and oral cavity Auscultation for bruits and murmurs Abdominal palpation for hepatosplenomegaly Rectal examination for abscesses Testicular examination Palpate for lymphadenopathy Focal neurologic signs Musculoskeletal: bony tenderness, joint effusion Examination
  13. 13. Differential Diagnosis Common Uncommon Tuberculosis All rest causes Abdominal and pelvic abscesses HIV Sinusitis: Acute or chronic Thyroiditis
  14. 14. References: 1) Harrison’s 19th edition 2) PUO, BMJ
  15. 15. Tuberculosis

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