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Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
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Pyrexia Of Unknown Origin (PUO)

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  • 1. Pyrexia of Unknown Origin PUO Prof. Nooruddin Jaffer HCMD Karachi
  • 2. PUO Definition <ul><li>Fever Persisting for more than 3 weeks. </li></ul><ul><li>Documented Temp above 101 F Several Occasions. </li></ul><ul><li>Uncertain diagnosis after extensive evaluation in hospital for . 1 week. </li></ul><ul><li>PUO of 2 weeks no diagnosis could be made. </li></ul>
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  • 5. Approach to Patient of PUO Painstaking History: A- Chronology of Symptoms. B- Occupational History. C- Travel History. D- Drug History. E- Geographical History. F- Past History
  • 6.  
  • 7. <ul><li>Pyrexia of Unknown Origin </li></ul><ul><li>Causes: </li></ul><ul><li>Infections. </li></ul><ul><li>Neoplastic Diseases. </li></ul><ul><li>Auto Immune Disease. </li></ul><ul><li>Hentable Diseases. </li></ul><ul><li>Granulamatous Disease. </li></ul><ul><li>Drug Fever. </li></ul><ul><li>Miscellaneous Causes. </li></ul>
  • 8. 1- Infections: <ul><li>Viral Syndrome 1. Cytomegalovirus. 2. Epstein-Barr Virus (Mononucleosis) 3. HIV Infection. </li></ul><ul><li>Lyme Disease </li></ul><ul><li>Pyelonephritis or Urinary Tract Infection </li></ul><ul><li>Meningitis. </li></ul><ul><li>Pneumonia </li></ul><ul><li>Septicemia </li></ul><ul><li>Acute Sinusitis </li></ul><ul><li>Malaria </li></ul>Causes
  • 9. <ul><li>Osteomyelitis. </li></ul><ul><li>Typhoid Fever or Enteric Fever </li></ul><ul><li>Subacute Bacterial Endocarditis (SBE) </li></ul><ul><li>Tuberculosis. </li></ul><ul><li>Liver or Biliary infection. </li></ul><ul><li>Abdominal or Pelvic abscess </li></ul><ul><li>Dental Abscess </li></ul><ul><li>Psittacosis </li></ul><ul><li>Brucellosis </li></ul>
  • 10. <ul><li>Tonsillitis or Peritonsillar Abscess </li></ul><ul><li>Herpes Simplex Virus </li></ul><ul><li>Streptococccosis </li></ul><ul><li>Gonococcal Arthritis </li></ul><ul><li>Prostatitis </li></ul>
  • 11. 2- Neoplastic Disease: A. Leukemia B. Lymphoma C. Sarcoma D. Carcinomatosis E. Renal cell carcinoma F. Colon Cancer G. Pancreatic H. Hepatoma I. Metastic cancer
  • 12. 3 - Autoimmune Disease: A. Juvenile Rheumatoid Arthritis (evanescent rash) B. Henoch-Schonlein Purpura C. Systemic Lupus Erythematosus D. Rheumatic Fever (Migratory Polyarthritis) E. Polymyalgia Rheumatica F. Temporal Arteritis G. Inflammatory Bowel Disease H. Reiter’s Syndrome
  • 13. 4 - Heritable Disease Causes: A. Fabry’s Disease B. Familial Mediterranean fever C. Lamellar Ichthyosis D. Nephrogenic Diabetes Insipidus E. Anhydrotic ectodermal dysplasia F. Familial Dysautonomia
  • 14. 5- Granulomatous Disease: A. Sarcoidosis B. Granulomatous Hepatitis C. Inflammatory Bowel Disease 7- Miscellaneous: A. Facticious Fever (Munchausen by proxy) B. Thyroiditis C. Neurogenic Fever D. Milk Allergy E. Behcet’s Syndrome F. Anicteric Hepatitis G. Pulmonary Embolism H. Deep Vein Thrombosis
  • 15. Drug-Induced Fever 1- Antibiotic Induced Fever: A. Erythromycin B. Isoniazid C. Penicillin D. Nitrofurantoin E. Procainamide F. Quinidine
  • 16. 2- Cardiovascular Medication Induced Fever: A. Atropine B. Captopril C. Clofibrate D. Hydralazine E. Hydrochlorothiazide F. Methyldopa G. Nifedipine
  • 17. 3 - Miscellaneous Medications Inducing Fever: A. Allopurinol B. Antihistamines C. Aspirin D. Cimetidine E. Heparin F. Meperidine G. Phenytoin
  • 18. Physical Examination in PUO <ul><li>Meticulous, repeated on regular basis. </li></ul><ul><li>Temp Chart. </li></ul><ul><li>Skin, Lymphnodes, Eyes, Nail Beds. </li></ul><ul><li>CVS, Chest, Abd, Musculoskeletal Sys, CNS. </li></ul><ul><li>Penis, Scrotum, Testes in males. </li></ul><ul><li>Pelvic examination in female. </li></ul>
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  • 24. Thank You
  • 25.  
  • 26. Pyrexia of Unknown Origin 1- Types: A. Pyrexia of Unknown Origin: 1. Daily or Intermittent Fever >= 38.3 C (101F) 2. Duration for three consecutive weeks 3. No source by clinical evaluation a. Hospital evaluation for 3 days (previously 7) or b. Intensive outpatient evaluation for 7 days or c. Three outpatient visits
  • 27. B. Nosocomial Fever or Unknown Origin: 1. Daily or Intermittent Fever >= 38.3 C (101F) 2. Hospitalized >1 day without fever on admission 3. Fever evaluation of 3 days of more C. Immune-Deficient Pyrexia of Unknown Origin: 1. Daily or Intermittent Fever >=38.3 C (101F) 2. Neutrophil count < 500 per mm3 3. Fever evaluation of 3 days of more
  • 28. D. HIV-Associated Fever of Unknown Origin: 1. Daily or Intermittent Fever >= 38.3 C (101F) 2. Outpatient Fever >4 weeks or 3. Inpatient fever >3 days
  • 29. Infection Microbiactoxins Mediators of inflammation Immune Reaction Monocytes / Macrophacites Endothelial Cells Pyogenic Cytokines I L-1, I L-6, INF, IFN Microbial Toxins Hypothalamic Endotelium
  • 30. PG E2 Cyclic AMP Elevated Thermoregulator Set Point Heat Conservation Heat Production Fever
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