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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
    • Fever Persisting for more than 3 weeks.
    • Documented Temp above 101 F Several Occasions.
    • Uncertain diagnosis after extensive evaluation in hospital for . 1 week.
    • PUO of 2 weeks no diagnosis could be made.
  • 3.  
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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.
    • Pyrexia of Unknown Origin
    • Causes:
    • Infections.
    • Neoplastic Diseases.
    • Auto Immune Disease.
    • Hentable Diseases.
    • Granulamatous Disease.
    • Drug Fever.
    • Miscellaneous Causes.
  • 8. 1- Infections:
    • Viral Syndrome 1. Cytomegalovirus. 2. Epstein-Barr Virus (Mononucleosis) 3. HIV Infection.
    • Lyme Disease
    • Pyelonephritis or Urinary Tract Infection
    • Meningitis.
    • Pneumonia
    • Septicemia
    • Acute Sinusitis
    • Malaria
    Causes
  • 9.
    • Osteomyelitis.
    • Typhoid Fever or Enteric Fever
    • Subacute Bacterial Endocarditis (SBE)
    • Tuberculosis.
    • Liver or Biliary infection.
    • Abdominal or Pelvic abscess
    • Dental Abscess
    • Psittacosis
    • Brucellosis
  • 10.
    • Tonsillitis or Peritonsillar Abscess
    • Herpes Simplex Virus
    • Streptococccosis
    • Gonococcal Arthritis
    • Prostatitis
  • 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
    • Meticulous, repeated on regular basis.
    • Temp Chart.
    • Skin, Lymphnodes, Eyes, Nail Beds.
    • CVS, Chest, Abd, Musculoskeletal Sys, CNS.
    • Penis, Scrotum, Testes in males.
    • Pelvic examination in female.
  • 19.  
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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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