Fever of unknown origin

2020 ◽  
pp. 664-669
Author(s):  
Steven Vanderschueren
Keyword(s):  
Rare Diseases ◽  
Broad Spectrum ◽  
Fever Of Unknown Origin ◽  
Febrile Illness ◽  
Unknown Origin ◽  
Clinical History ◽  
The Body ◽  
Initial Assessment ◽  
Drug Fever ◽  
Inflammatory Conditions

Fever of unknown origin refers to a prolonged febrile illness that persists without diagnosis after careful initial assessment. Although over 200 causes have been described, including rare diseases, most cases are due to familiar entities presenting in an atypical fashion. The ‘big three’ are infections, tumours, and multisystem inflammatory conditions. A miscellaneous category including factitious fever, habitual hyperthermia, and drug fever deserves consideration early in a patient’s workup, since timely recognition may avert invasive and expensive procedures. The clinician must rely on a very careful and thorough clinical history and examination that does not neglect any part of the body, followed by appropriately targeted investigations directed by knowledge of the broad spectrum of diseases and local epidemiology.

Liver-Spleen Scanning in Pediatrics

PEDIATRICS ◽  
1974 ◽  
Vol 53 (5) ◽  
pp. 692-701
Author(s):  
Nancy Rosenfield ◽  
S. Treves
Keyword(s):  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Anatomical Variations ◽  
Healthy Children ◽  
Tumor Patients ◽  
Diffuse Liver Disease ◽  
Inflammatory Conditions ◽  
Abdominal Masses ◽  
Liver Scan ◽  
Iodine 131

Liver-spleen scans on 254 children were reviewed retrospectively with regard to accuracy and yield of the examination. The scan predicted abnormality correctly 95% of the time and normality correctly 86% of the time. Pitfalls in interpretation include the nonspecificity of abnormalities present on the scan, confusion of extrinsic with intrinsic defects, and normal anatomical variations with pathology. The technetium-99m-sulfur colloid scan was found to be most helpful in diagnosing splenic abnormalities, in working up abdominal masses, and in evaluating tumor patients after a baseline scan. It was found least useful in patients with fever of unknown origin, abdominal pain, diffuse liver disease, and most inflammatory conditions. Liver abscesses were not found in febrile, otherwise healthy children. The iodine-131-rose bengal liver scan was found to be useful to differentiate potentially curable lesions (e.g., choledochal cysts) from those not surgically treatable.

scholarly journals Questing one Brazilian query: reporting 16 cases of Q fever from Minas Gerais, Brazil

2006 ◽  
Vol 48 (1) ◽  
pp. 5-9 ◽  
Author(s):  
Paulo Sérgio Gonçalves da Costa ◽  
Marco Emilio Brigatte ◽  
Dirceu Bartolomeu Greco
Keyword(s):  
Phase I ◽  
Phase Ii ◽  
Fever Of Unknown Origin ◽  
Q Fever ◽  
Acute Infection ◽  
Case Series ◽  
Febrile Illness ◽  
Unknown Origin ◽  
Clinical Form ◽  
Chronic Q Fever

Q fever has been considered non-existing in Brazil where reports of clinical cases still cannot be found. This case-series of 16 patients is a result of a systematic search for such illness by means of clinical and serologic criteria. Serologic testing was performed by the indirect microimmunofluorescence technique using phase I/II C. burnetii antigens. Influenza-like syndrome was the most frequent clinical form (eight cases - 50%), followed by pneumonia, FUO (fever of unknown origin), mono-like syndrome (two cases - 12.5% each), lymphadenitis (one case - 6.3%) and spondylodiscitis associated with osteomyelitis (one case - 6.3%). The ages varied from four to 67 years old with a median of 43.5. All but one patient had positive serologic tests for phase II IgG whether or not associated with IgM positivity compatible with acute infection. One patient had both phase I and phase II IgG antibodies compatible with chronic Q fever. Seroconvertion was detected in 10 patients. Despite the known limitations of serologic diagnosis, the cases here reported should encourage Brazilian doctors to include Q fever as an indigenous cause of febrile illness.

Fever of Unknown Origin

2016 ◽  
Author(s):  
Annie Antar
Keyword(s):  
Best Management Practices ◽  
Fever Of Unknown Origin ◽  
Management Practices ◽  
Unknown Origin ◽  
Clinical History ◽  
Definitive Diagnosis ◽  
Know How ◽  
Best Management ◽  
Definition Of ◽  
Immunocompetent Patients

This chapter on fever of unknown origin (FUO) begins by clarifying the definition of FUO and continues by listing and describing the major etiologies of FUO, providing guidance on clinical workup and discussing best management practices. Discussion of FUO etiologies emphasizes that most fall under a few categories—rheumatological, infectious, neoplastic, and other. Emergency management of stable, immunocompetent patients with FUO is best when focused on an appropriate diagnostic workup so that a definitive diagnosis can be established and treated with targeted therapy. Antibiotics should not be started in the emergency department for stable, immunocompetent patients with FUO unless the specific etiology is uncovered. This chapter is concise and targeted to the emergency medicine provider who needs to know how best to evaluate and manage the patient with a clinical history consistent with FUO.

scholarly journals From Prolonged Febrile Illness to Fever of Unknown Origin

2003 ◽  
Vol 163 (9) ◽  
pp. 1033 ◽  
Author(s):  
Steven Vanderschueren ◽  
Daniël Knockaert ◽  
Tom Adriaenssens ◽  
Wim Demey ◽  
Anne Durnez ◽  
...  
Keyword(s):  
Fever Of Unknown Origin ◽  
Febrile Illness ◽  
Unknown Origin

National survey of childhood febrile illness cases with fever of unknown origin in Japan

2011 ◽  
Vol 53 (4) ◽  
pp. 421-425 ◽  
Author(s):  
Kazuko Kasai ◽  
Masaaki Mori ◽  
Ryoki Hara ◽  
Takako Miyamae ◽  
Tomoyuki Imagawa ◽  
...  
Keyword(s):  
National Survey ◽  
Fever Of Unknown Origin ◽  
Febrile Illness ◽  
Unknown Origin

Fever of unknown origin (FUO) in a renal transplant recipient due to drug fever from sirolimus

Infection ◽  
2016 ◽  
Vol 44 (4) ◽  
pp. 559-561 ◽  
Author(s):  
Sairah Sharif ◽  
May W. Kong ◽  
James Drakakis ◽  
Burke A. Cunha
Keyword(s):  
Renal Transplant ◽  
Transplant Recipient ◽  
Renal Transplant Recipient ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Drug Fever

scholarly journals Threat of scrub typhus in post-earthquake Nepal

2017 ◽  
Vol 6 (4) ◽  
pp. 1-6 ◽  
Author(s):  
S Thapa ◽  
L B Sapkota ◽  
P Hamal
Keyword(s):  
Fever Of Unknown Origin ◽  
Scrub Typhus ◽  
Febrile Illness ◽  
Unknown Origin ◽  
Serum Samples ◽  
Mortality And Morbidity ◽  
Medical College ◽  
Recent Outbreak ◽  
High Index Of Suspicion ◽  
A Prospective Study

Scrub typhus is a potentially fatal zoonotic infection, reported from many parts of Asia including Nepal. There is in­creasing reports of outbreak of Scrub typhus, after the earthquake hit Nepal on April 25, 2015. The recent outbreak of Scrub typhus posed problems in diagnosis and treatment of the disease. It may be related to poor awareness of the disease or lack of suspicion for Scrub typhus which often presents with clinical features indistinguishable from typhoid fever. Since, various parts of Nepal appeared to be suitable hubs for Scrub typhus, the clinical suspicion of Scrub typhus in the differential diagnosis of fever of unknown origin (FUO) is of utmost importance to prevent mortality and morbidity. This is a prospective study conducted in Chitwan Medical College (CMC), Chitwan, Nepal. This study was carried out over a period of 4 months extending from June 2016 to September 2016. A total of 410 serum samples were collected from all patients visiting CMC, clinically suspected of having Scrub typhus infec­tion. The samples were processed for the detection of IgM antibodies for Scrub typhus by ELISA. Results: A total of 410 samples from patients suspected with Scrub typhus infection were processed which included 200 males and 210 females. Out of total 410 samples tested, 181 (44.1%) were seropositive for Scrub typhus. Seropositivity was highest 25.9% among the age group 11-20 years of age. Females were infected more than males. This study implies the re-emergence of Scrub typhus in different regions of Nepal. Although the disease is endemic in our country, it is grossly underdiagnosed owing to non-specific clinical presentation and lack of diagnostic facilities. It is thus suggested that high index of suspicion should be maintained for cases presenting with febrile illness. Infection with Scrub typhus was found high and this calls for an urgent need to introduce vaccine against Scrub typhus. 

scholarly journals CLINICOPATHOLOGICAL PROFILE OF SALMONELLA TYPHI AND PARATYPHI INFECTIONS PRESENTING AS FEVER OF UNKNOWN ORIGIN IN A TROPICAL COUNTRY.

2015 ◽  
Vol 7 ◽  
pp. e2015021
Author(s):  
Nayyar Iqbal ◽  
Aneesh Basheer ◽  
Sudhagar Mookkappan ◽  
Anita Ramdas ◽  
Renu G'Boy Varghese ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Enteric Fever ◽  
Fever Of Unknown Origin ◽  
Clinical Laboratory ◽  
Febrile Illness ◽  
Unknown Origin ◽  
Salmonella Typhi ◽  
Common Symptom ◽  
Tropical Country ◽  
The Tropics

Background: Enteric fever, a common infection in the tropics and endemic to India, often manifests as an acute febrile illness. However, presentation as fever of unknown origin (FUO) is not uncommon in tropical countries. Methods: We aim to describe the clinical, laboratory and pathological features of cases hospitalized with fever of unknown origin and diagnosed as enteric fever. All culture proven cases of enteric fever were analyzed retrospectively over a period of three years from January 2011 to December 2013.Results: Seven of 88(8%) cases with enteric fever presented as FUO. Abdominal pain was the most common symptom besides fever. Relative bradycardia and splenomegaly were uncommon. Thrombocytopenia was the most common haematological abnormality, while leucopenia was rare. Transaminase elevation was almost universal. S.Typhi and S.Paratyphi were isolated from six cases and one case respectively.  Yield of organisms from blood culture was superior to that of bone marrow aspirate. Multiple granulomas were identified in 4 out of 6 (67%) of the bone marrows studied, including that due to S. Paratyphi and histiocytic hemophagocytosis was noted in two cases.Conclusion: FUO is a relatively common manifestation of enteric fever in the tropics. Clinical and laboratory features may be atypical in such cases, including absence of relative bradycardia, leucopenia and presence of thrombocytopenia, bicytopenia or pancytopenia.  Moreover, in endemic countries, enteric fever should be considered as a differential diagnosis, next to tuberculosis, in the evaluation of bone marrow granulomas in cases with FUO and culture correlation should be mandatory.

scholarly journals Fever of unknown origin in special groups

2019 ◽  
Vol 65 (10) ◽  
pp. 1308-1313
Author(s):  
Leonardo Fernandes e Santana ◽  
Mateus de Sousa Rodrigues ◽  
Marylice Pâmela de Araújo Silva ◽  
Rodrigo José Videres Cordeiro de Brito ◽  
Jandir Mendonça Nicacio ◽  
...  
Keyword(s):  
Physical Examination ◽  
Fever Of Unknown Origin ◽  
Inflammatory Diseases ◽  
Empirical Therapy ◽  
Unknown Origin ◽  
Clinical History ◽  
Outpatient Visits ◽  
Special Groups ◽  
The World ◽  
Detailed Clinical History

SUMMARY Fever of undetermined origin (FUO) is a challenging entity with a striking presence in hospitals around the world. It is defined as temperature ≥ 37.8 ° C on several occasions, lasting ≥ three weeks, in the absence of diagnosis after three days of hospital investigation or 3 outpatient visits. The main etiologies are infectious, neoplastic, and non-infectious inflammatory diseases. The diagnosis is based on the detailed clinical history and physical examination of these patients, in order to direct the specific complementary tests to be performed in each case. The initial diagnostic approach of the FUO patient should include non-specific complementary exams. Empirical therapy is not recommended (with few exceptions) in patients with prolonged fever, as it may disguise and delay the diagnosis and conduct to treat the specific etiology. The prognosis encompasses mortality of 12-35%, varying according to the baseline etiology.

scholarly journals Disseminated cryptococcal disease during treatment with idelalisib and corticosteroids for follicular lymphoma

2020 ◽  
Vol 13 (7) ◽  
pp. e235216
Author(s):  
Paul J Hengeveld ◽  
Eva de Jongh ◽  
Peter E Westerweel ◽  
Mark-David Levin
Keyword(s):  
Follicular Lymphoma ◽  
T Lymphocyte ◽  
Broad Spectrum ◽  
Clinical Condition ◽  
Lymphocyte Count ◽  
Fever Of Unknown Origin ◽  
Opportunistic Infections ◽  
Unknown Origin ◽  
Emergency Ward ◽  
Cryptococcal Disease

A patient on a regimen of idelalisib and corticosteroids for a relapse of follicular lymphoma presented to our emergency ward with a fever of unknown origin. Despite the initiation of broad-spectrum antibiotics and fluids, the patient’s clinical condition deteriorated. Eventually, a diagnosis of disseminated cryptococcosis was established and immunophenotyping revealed complete absence of circulating B and CD4+-T lymphocytes, and a markedly diminished CD8+-T lymphocyte count. In this case, treatment with idelalisib and corticosteroids likely resulted in profound lymphopenia and the first reported instance of disseminated cryptococcosis under this regimen. After the withdrawal of idelalisib and steroids and initiation of antifungal therapy, lymphocyte counts partially recovered. After clinical improvement, the patient could be discharged from the hospital. This case highlights that the combination of idelalisib and corticosteroids can cause significant immunocompromise and opportunistic infections. Additionally, we illustrate the rate of lymphocyte reconstitution after withdrawal from idelalisib and corticosteroids.

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