Fever of unknown origin resident survival guide
| Fever of unknown origin Resident Survival Guide |
|---|
| Diagnostic Criteria |
| Classification |
| Causes |
| Focused Initial Rapid Evaluation |
| Empiric Therapy |
| Dos |
| Don'ts |
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.; FUO; PUO; pyrexia of unknown origin
Diagnostic Criteria
In 1961, Petersdorf and Beeson suggested the following criteria:[1][2]
- Fever higher than 38.3°C (100.9°F) on several occasions
- Persisting without diagnosis for at least 3 weeks
- At least 1 week's investigation in hospital
Classification
In 1991, Durack and Street proposed a revised definition in which cases of FUO are categorized into four subclasses: classic FUO, nosocomial (health care-associated) FUO, neutropenic (immune-deficient) FUO, and HIV-related FUO.[3]
Classic FUO
Fever (>38.3° C or >100.9° F) for >3 weeks with no identified cause after 3 days of hospital evaluation or ≥3 outpatient visits
Nosocomial (health care-associated) FUO
Fever (>38.3° C or >100.9° F) in hospitalized patients receiving acute care and with no infection present or incubating on admission if the diagnosis remains uncertain after 3 days of appropriate evaluation
Neutropenic (immune-deficient) FUO
Fever (>38.3° C or >100.9° F) in patients with immunodeficiencies if the diagnosis remains uncertain after 3 days of appropriate evaluation, including negative cultures after 48 hours
Fever (>38.3° C or >100.9° F) for >3 weeks in outpatients with confirmed HIV infection or >3 days in inpatients with confirmed HIV infection if the diagnosis remains uncertain after appropriate evaluation
Causes
- Infections
- Localized
- Endocarditis
- Intraabdominal infections
- Urinary tract infections
- Osteomyelitis
- Upper respiratory tract infections
- Infected peripheral vessels
- Generalized
- Bacterial
- Mycobacterial
- Fungal
- Viral
- Parasitic
- Neoplasia
- Lymphoproliferative disorders
- Leukemia
- Myelodysplastic diseases
- Solid tumors
- Rheumatologic disorders
- Adult Still's disease
- Giant cell arteritis
- Polymyalgia rheumatica
- Other forms of vasculitis (e.g., polyarteritis nodosa, Wegener's granulomatosis, Takayasu's arteritis)
- Other rheumatologic disorders (e.g., systemic lupus erythematosus, rheumatoid arthritis, Sjogren's disease)
- Miscellaneous
- Granulomatous disorders
- Alcoholic hepatitis
- Vascular disorders (pulmonary embolism, hematoma)
- Drug fever
- Hereditary (e.g., familial Mediterranean fever)
- Endocrine
- Hyperthyroidism
- Thyroiditis
- Adrenocortical insufficiency
- Factitious fever
FIRE: Focused Initial Rapid Evaluation
Focused Initial Rapid Evaluation (FIRE) should be undertaken to identify patients requiring urgent intervention.
Abbreviations: CBC, complete blood count; CI, cardiac index; CK-MB, creatine kinase MB isoform; CVP, central venous pressure; DC, differential count; ICU, intensive care unit; INR, international normalized ratio; LFT, liver function test; MAP, mean arterial pressure; PCWP, pulmonary capillary wedge pressure; PT, prothrombin time; PTT, partial prothrombin time; SaO2, arterial oxygen saturation; SBP, systolic blood pressure; ScvO2, central venous oxygen saturation; SvO2, mixed venous oxygen saturation; SMA-7, sequential multiple analysis-7.
Suspected FUO | |||||||||
Empiric Antibiotic Therapy
Dos
Don'ts
References
- ↑ 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
- ↑ Harrison's Principles of Internal Medicine 16th Edition, The McGraw-Hill Companies, ISBN 0-07-140235-7
- ↑ Durack, D. T.; Street, A. C. (1991). "Fever of unknown origin--reexamined and redefined". Current Clinical Topics in Infectious Diseases. 11: 35–51. ISSN 0195-3842. PMID 1651090.