Fever of unknown origin other diagnostic studies: 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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{{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
{{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


==Imaging Studies==
==Overview==
 
Other than laboratory work up some other investigation listed below may be helpful in finding cause of FUO.<ref name="pmid26031980">{{cite journal| author=Mulders-Manders C, Simon A, Bleeker-Rovers C| title=Fever of unknown origin. | journal=Clin Med (Lond) | year= 2015 | volume= 15 | issue= 3 | pages= 280-4 | pmid=26031980 | doi=10.7861/clinmedicine.15-3-280 | pmc=4953114 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26031980  }}</ref><ref name="pmid23977936">{{cite journal| author=Kaya A, Ergul N, Kaya SY, Kilic F, Yilmaz MH, Besirli K | display-authors=etal| title=The management and the diagnosis of fever of unknown origin. | journal=Expert Rev Anti Infect Ther | year= 2013 | volume= 11 | issue= 8 | pages= 805-15 | pmid=23977936 | doi=10.1586/14787210.2013.814436 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23977936  }}</ref>
===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]] using radioactively labelled [[fluorodeoxyglucose]] (FDG) has been reported to have a [[Sensitivity (tests)|sensitivity]] of 84% and a [[Specificity (tests)| specificity]] of 86% for localizing the nidus of fever of unknown origin.<ref>{{cite journal | author = Meller J, Altenvoerde G, Munzel U, Jauho A, Behe M, Gratz S, Luig H, Becker W | title = Fever of unknown origin: prospective comparison of [18F]FDG imaging with a double-head coincidence camera and gallium-67 citrate SPET. | journal = Eur J Nucl Med. | volume = 27| issue = 11 | pages = 1617-25 | year = 2000 | id = PMID 11105817}}</ref>


==Other Diagnostic Studies==
==Other Diagnostic Studies==


===Tissue Biopsy===
===Lymph Node Biopsy===
Invasive techniques (biopsy and laparotomy for pathological and bacteriological examination) may be required to make a definitive diagnosis.<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>
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.
 
==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 nodes to biopsy are the posterior cervical, epitrochlear, or supraclavicular nodes.
 
===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===
===Bone Marrow Biopsy===
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.<ref name="Mandell"/>
Bone marrow biopsy may be considered when there are clues for hematologic malignancies.


===Naproxen Test===
===Naproxen Test===
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{{Reflist|2}}
{{Reflist|2}}


[[Category:Infectious disease]]
[[Category:Medical signs]]
[[Category:Symptoms]]
[[Category:Ailments of unknown etiology]]
[[Category:Ailments of unknown etiology]]
[[Category:Signs and symptoms]]

Latest revision as of 23:41, 27 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

Overview

Other than laboratory work up some other investigation listed below may be helpful in finding cause of FUO.[1][2]

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.

Bone Marrow Biopsy

Bone marrow biopsy may be considered when there are clues for hematologic malignancies.

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.[3]

References

  1. Mulders-Manders C, Simon A, Bleeker-Rovers C (2015). "Fever of unknown origin". Clin Med (Lond). 15 (3): 280–4. doi:10.7861/clinmedicine.15-3-280. PMC 4953114. PMID 26031980.
  2. Kaya A, Ergul N, Kaya SY, Kilic F, Yilmaz MH, Besirli K; et al. (2013). "The management and the diagnosis of fever of unknown origin". Expert Rev Anti Infect Ther. 11 (8): 805–15. doi:10.1586/14787210.2013.814436. PMID 23977936.
  3. 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)