Fever of unknown origin: Difference between revisions
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{{SK}} pyrexia of unknown origin, PUO, febris e causa ignota, febris E.C.I. | {{SK}} pyrexia of unknown origin, PUO, febris e causa ignota, febris E.C.I. | ||
==Some important causes== | ==Some important causes== | ||
Revision as of 14:16, 19 October 2012
| Fever of unknown origin | |
| ICD-10 | R50 |
|---|---|
| ICD-9 | 780.6 |
| MedlinePlus | 003090 |
| MeSH | D005335 |
Template:Search infobox Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: pyrexia of unknown origin, PUO, febris e causa ignota, febris E.C.I.
Some important causes
Extrapulmonary tuberculosis is the most frequent cause of FUO.[1] Drug fever, as sole symptom of an adverse reaction to medication, should always be thought of. Disseminated granulomatoses such as Tuberculosis, Histoplasmosis, Coccidioidomycosis, Blastomycosis and Sarcoidosis are associated with FUO.
Lymphomas are the most common cause of FUO in adults. Thromboembolic disease (i.e. pulmonary embolism, deep venous thrombosis) occasionally shows fever. Although infrequent, its potentially lethal consequences warrant evaluation of this cause. Endocarditis, although uncommon, is another important thing to consider. An underestimated reason is factitious fever. Patients frequently are women that work, or have worked, in the medical field and have complex medical histories.[2]
Diagnosis
A comprehensive and meticulous history (i.e. illness of family members, recent visit to the tropics, medication), repeated physical examination (i.e. skin rash, eschar, lymphadenopathy, heart murmur) and a myriad of laboratory tests (serological, blood culture, immunological) are the cornerstone of finding the cause.[2][3]
Other investigations may be needed. Ultrasound may show cholelithiasis, echocardiography may be needed in suspected endocarditis and a CT scan may show infection or malignancy of internal organs. Another technique is Gallium-67 scanning which seems to visualize chronic infections more effectively. Invasive techniques (biopsy and laparotomy for pathological and bacteriological examination) may be required before a definite diagnosis is possible.[2][3]
Positron Emission Tomography using radioactively labelled Fluorodeoxyglucose (FDG) has been reported to have a sensitivity of 84% and a specificity of 86% for localizing the source of fever of unknown origin.[4]
Despite all this, diagnosis may only be suggested by the therapy chosen. When a patient recovers after discontinuing medication it likely was drug fever, when antibiotics or antimycotics work it probably was infection. Empirical therapeutic trials should be used in those patients in which other techniques have failed.[2]
Therapy
Unless the patient is acutely ill, no therapy should be started before the cause has been found. This is because non-specific therapy rarely is effective and mostly delays diagnosis. An exception is made for neutropenic patients in which delay could lead to serious complications. After blood cultures are taken this condition is aggressively treated with broad-spectrum antibiotics. Antibiotics are adjusted according to the results of the cultures taken.[2][1][3]
HIV-infected persons with pyrexia and hypoxia, will be started on medication for possible Pneumocystis jirovecii infection. Therapy is adjusted after a diagnosis is made.[3]
Prognosis
Since there is a wide range of conditions associated with FUO, prognosis depends on the particular cause.[2] If after 6 to 12 months no diagnosis is found, the chances diminish of ever finding a specific cause.[3] However, under those circumstances prognosis is good.[1]
References
- ↑ 1.0 1.1 1.2
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5
- ↑ 3.0 3.1 3.2 3.3 3.4
- ↑ 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.
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