Fever of unknown origin history and symptoms
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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
Key components of history include:
- Pattern or periodicity of the fever
- History of previous surgeries or procedures
- History of malignancy and related therapy
- History of previously treated infections
- History of sick or animal contacts
- History of psychiatric illness
- History of recent traveling
- History of comorbidities
- History of medications
- History of transfusions
- Social and family history
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.