Fever of unknown origin medical therapy: Difference between revisions

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Latest revision as of 15:19, 25 January 2021

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

Since FUO can have variety of etiologies therefore it does not have a standard treatment regimen. However the treatment is usually directed towards the target from potential clues in the History and Physical examination.^[1]^[2]

Medical Therapy

Empiric antibiotics

Use of empiric antibiotics should not be encouraged unless the patient is neutropenic or immunocompromised, so that proper workup can be done and a more targeted treatment be given.

Steroids

Steroids should not be given early as it can mask effects of many diseases.
however they can be given early in cases of Giant cell temporal arteritis to prevent blindness.
they are used in rheumatologic causes of FUO.

NSAIDS

Non-steroidal anti-inflammatory drugs are given when no cause is found despite extensive work up.

Anakinra

Interleukin 1 antagonist are give in cases of autoimmune disorders. If no symptomatic improvement occurs after 2 weeks drug should be stopped.

References

↑ 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.
↑ Wright WF, Auwaerter PG (2020). "Fever and Fever of Unknown Origin: Review, Recent Advances, and Lingering Dogma". Open Forum Infect Dis. 7 (5): ofaa132. doi:10.1093/ofid/ofaa132. PMC 7237822 Check |pmc= value (help). PMID 32462043 Check |pmid= value (help).

[pmid26031980-1] 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.

[pmid32462043-2] Wright WF, Auwaerter PG (2020). "Fever and Fever of Unknown Origin: Review, Recent Advances, and Lingering Dogma". Open Forum Infect Dis. 7 (5): ofaa132. doi:10.1093/ofid/ofaa132. PMC 7237822 Check |pmc= value (help). PMID 32462043 Check |pmid= value (help).

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@@ Line 7: / Line 7: @@
 ==Overview==
-Management of fever of unknown origin (FUO) should generally be withheld until the etiology of the fever has been determined, so that treatment can be directed against a specific pathology.  However, empiric corticosteroids may be appropriate in patients with suspected temporal arteritis to prevent vascular complications.  Patients with febrile neutropenia should receive broad-spectrum antipseudomonal antibiotics immediately after specimens for cultures have been obtained.
+Since FUO can have variety of etiologies therefore it does not have a standard treatment regimen. However the treatment is usually directed towards the target from potential clues in the History and Physical examination.<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="pmid32462043">{{cite journal| author=Wright WF, Auwaerter PG| title=Fever and Fever of Unknown Origin: Review, Recent Advances, and Lingering Dogma. | journal=Open Forum Infect Dis | year= 2020 | volume= 7 | issue= 5 | pages= ofaa132 | pmid=32462043 | doi=10.1093/ofid/ofaa132 | pmc=7237822 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32462043  }}</ref>
 ==Medical Therapy==
-Unless the patient is acutely ill, no therapy should be initiated before the cause has been determined. In the majority of classic FUO, non-specific therapy is ineffective and delays diagnosis.
-===Febrile Neutropenia===
+=== Empiric antibiotics ===
-{{Seealso|Febrile neutropenia medical therapy}}
+Use of empiric antibiotics should not be encouraged unless the patient is neutropenic or immunocompromised, so that proper workup can be done and a more targeted treatment be given.
-Exception may be made for neutropenic patients in which delayed treatment could lead to serious complications.
+=== Steroids ===
-After samples for cultures are obtained, febrile neutropenia should be aggressively treated with broad-spectrum antipseudomonal antibiotics. The antimicrobial regimen should be modified in accordance with the culture results.<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>
+* Steroids should not be given early as it can mask effects of many diseases.
+* however they can be given early in cases of Giant cell temporal arteritis to prevent blindness.
+* they are used in rheumatologic causes of FUO.
-===HIV/AIDS patients===
+=== NSAIDS ===
-HIV-infected persons with pyrexia and [[hypoxia (medical)|hypoxia]], should be placed on therapy for [[Pneumocystis pneumonia|''Pneumocystis jirovecii'' infection]] and adjusted once the diagnosis is confirmed.<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>
+Non-steroidal anti-inflammatory drugs are given when no cause is found despite extensive work up.
-===Giant Cell Arteritis===
-Empiric [[corticosteroids]] may be considered in patients with suspected [[giant cell arteritis]] to prevent vascular complications such as [[stroke]] and [[blindness]].  Giant cell arteritis should be suspected in a patient over the age of 50 with the following symptoms:
-* Newly onset [[headaches]]
-* Abrupt onset of [[blurry vision]]
-* Symptoms of [[polymyalgia rheumatica]]
-* [[Jaw claudication]]
-* Unexplained [[anemia]]
-* Elevated [[ESR|erythrocyte sedimentation rate (ESR)]] and/or [[CRP|C-reactive protein (CRP)]]
+=== Anakinra ===
+Interleukin 1 antagonist are give in cases of autoimmune disorders. If no symptomatic improvement occurs after 2 weeks drug should be stopped.
+<br />
 ==References==
 {{Reflist|2}}
-[[Category:Infectious disease]]
 [[Category:Ailments of unknown etiology]]