Fever of unknown origin medical therapy: Difference between revisions

	Fever of unknown origin Microchapters
Home
Patient Information
Overview
Historical perspective
Pathophysiology
Causes
Differentiating Fever of unknown origin from other Diseases
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
Diagnostic study of choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and ultrasound
CT scan
MRI
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Fever of unknown origin medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Fever of unknown origin medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Fever of unknown origin medical therapy
CDC on Fever of unknown origin medical therapy
Fever of unknown origin medical therapy in the news
Blogs on Fever of unknown origin medical therapy
Directions to Hospitals Treating Fever of unknown origin
Risk calculators and risk factors for Fever of unknown origin medical therapy

VisualWikitext

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).

[1]

[2]

@@ 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==
-* Fever of unknown origin (FUO) treatment <ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-::* Management should generally be withheld until the etiology of the fever has been ascertained, so that treatment can be directed against a specific pathology.
-::* Specific clinical considerations
-:::* 1.'''Neutropenic fever'''
-::::* Exception may be made for neutropenic patients in which delayed treatment could lead to serious complications.
-::::* After samples for cultures are obtained, patients with febrile neutropenia should be aggressively treated with broad-spectrum antibiotics covering ''[[Pseudomonas]]''
-:::* 2.'''HIV/AIDS individuals'''
-::::* HIV/AIDS individuals with pyrexia and [[hypoxia]] should be placed on empiric therapy for ''[[Pneumocystis jirovecii]]''.
-:::* 3.'''Giant cell arteritis'''
-::::* Empiric [[corticosteroids]] may be considered in patients with suspected [[giant cell arteritis]] to prevent vascular complications.
-::::* 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]] and/or [[CRP]]
+=== 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.
+<br />
 ==References==
 {{Reflist|2}}
 [[Category:Ailments of unknown etiology]]