Pyrexia of unknown summary
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Pyrexia of unknown summary






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Pyrexia of unknown summary Presentation Transcript

  • 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