Your SlideShare is downloading. ×
Pyrexia of unknown summary
Pyrexia of unknown summary
Upcoming SlideShare
Loading in...5

Thanks for flagging this SlideShare!

Oops! An error has occurred.

Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Pyrexia of unknown summary


Published on

1 Like
  • Be the first to comment

No Downloads
Total Views
On Slideshare
From Embeds
Number of Embeds
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

No notes for slide


  • 1. PUO 4) OthersDefinition: • Drug fever• Fever >3 wks (> 38.3 oC) • Pulm embolism/DVT• Resists Dx after 1 wk of invx • Crohns disease / Ulcerative colitis • SarcoidosisCauses: • Amyloidosis1) Infections • Stroke/ICH• Lung –empyema, abscess, TB do CXR, and culture sputum, urineand gastric aspirate History• Heart—endocarditis, rheum fever • Fever onset and pattern, duration• Liver -- abscess, • Rashes / itch• GU/GI: subphrenic, perinephric, pelvic, UTI • Night sweats• Bacterial - salmonella, brucella, borrelia, leptospirosis - do • Lumps / lymphadenopathyWWF(Widal Weil Felix) test Widal for S typhi and paratyphi, WF for • DiarrhoeaRickettsia • Drugs• Malaria • Immunization hx• Dengue fever • LOA/LOW• Melioidosis • travel hx up to a year ago• Fungi • Contact, Sexual hx• HIV • IV drug abuse, blood transfusions• Other granulomas - actinomycosis, toxoplasmosis • Immunosuppressive illness• Parasites - amoebic liver abscesses, schistosomiasis, • Pets / animal contacttrypanosomiasis • Insect bites / cuts2) Neoplasms Physical exam:• Lymphomas - commonest malignancy in PUO • Teeth• Solid tumours eg RCC, colon CA, HCC • Rectal/ vaginal exam • Skin and mucosal lesions3) Connective tissue disease • Lymphadenopathy• RA • Hepatosplenomegaly• SLE • Joints examination• PAN• Kawasaki disease Invxs:• Giant cell arteritis • FBC, WBC d/dx count, blood films for malaria, ESR, CRP, U/E/Cr• Stills disease • LFT• polymyalgia rheumatica • blood C/S - several repeat cultures. If on ABx, may need to stop for 48-72 h b4 taking blood. At least 2x sets at 2 diff sites 30 min apart.
  • 2. WWF, PBF, Serologies (dengue, Rickettesial typhi, Orientia tsutsugamushi, leptospirosis etc etc)• Sputum - culture and microscopy/AFB/fungal/cytology• Urine - dipstick, microscopy, culture• Stool - ova, cysts and parasites• CXR• Rh factor, ANA, ds-DNA, anti-streptolysin titre, cryoglobulins, ANCA• Mantoux test• ECG• Lumbar puncture• Bone marrow aspirate, LN Bx• Temporal artery biopsy• PSA, CEA• CT abdo, IVU, barium studies, exploratory laparotomy• Liver biopsyTrial of Rx: Treat as for TB, endocarditis, vasculitis. Trial of aspirin /steroids Digitally signed by DR WANA HLA SHWE DN: cn=DR WANA HLA SHWE, c=MY, o=UCSI University, School of Medicine, KT- Campus, Terengganu, ou=Internal Medicine Group, Reason: This document is for UCSI year 4 students. Date: 2009.02.22 15:21:23 +0800