This document discusses pyrexia of unknown origin (PUO). It begins by defining PUO according to old and new definitions. It then expands the new definition to include categories like nosocomial PUO, neutropenic PUO, and HIV-associated PUO. The document goes on to discuss the causes of PUO in different regions and time periods, with infectious diseases like tuberculosis being very common. It also outlines the evaluation and diagnostic approach for PUO, including relevant laboratory tests, physical exam findings, and potential etiologies.
PYREXIA OF UNKNOWN ORIGIN (PUO) refers to unexplained fever that persists for at least 3 weeks. Common causes include infectious diseases (40-60% of cases), autoimmune diseases (10-20% of cases), and malignancies. Evaluation involves detailed history, physical exam, and tiered testing including basic labs, imaging, and potentially bone marrow biopsy depending on findings. The most frequent cause varies by age, with infections more common in children under 6 and autoimmune diseases increasing thereafter. Careful examination and consideration of exposures can help identify infectious etiologies while abnormal findings may suggest alternative diagnoses.
This document discusses pyrexia of unknown origin (PUO). It defines PUO as a fever over 38°C lasting more than 3 weeks without an obvious cause despite evaluations. Common causes include infections (40%), malignancies (25%), and autoimmune diseases (15%). The document outlines the pathogenesis of fever and classifications of PUO. It describes the approach to evaluating a PUO patient through history, exam, and staged laboratory/imaging investigations. Empirical treatment trials are generally not recommended until a cause is found due to risks of misleading outcomes. The prognosis is determined by the underlying disease, with neoplasms having the worst outcomes.
This document discusses fever of unknown origin (FUO). It begins by classifying FUO into categories like classical FUO and nosocomial FUO. It then discusses the epidemiology and common etiologies of FUO, which include infections, collagen vascular diseases, and malignancies. The diagnostic approach involves a thorough history, repeated physical exams, and diagnostic testing like blood tests, imaging, and biopsies. Empirical therapeutic drug trials can help diagnose certain conditions but have limitations. The prognosis depends on the underlying cause, with poorer outcomes seen in elderly patients or those with neoplasms or diagnostic delays.
Approach to a patient with fever of unknown origin sunil kumar daha
Please find the power point on Approach to a patient with fever of unknown origin . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
1. Fever of unknown origin (FUO) is defined as a fever over 38.3°C for more than 3 weeks without a diagnosis after 1 week of investigation.
2. There are four main classifications of FUO: classic FUO, nosocomial FUO, neutropenic FUO, and HIV-associated FUO.
3. Infections, neoplasms, and noninfectious inflammatory diseases are the most common causes of classic FUO in adults, with tuberculosis, typhoid fever, and malaria among the leading infectious causes.
PYREXIA OF UNKNOWN ORIGIN (PUO) refers to unexplained fever that persists for at least 3 weeks. Common causes include infectious diseases (40-60% of cases), autoimmune diseases (10-20% of cases), and malignancies. Evaluation involves detailed history, physical exam, and tiered testing including basic labs, imaging, and potentially bone marrow biopsy depending on findings. The most frequent cause varies by age, with infections more common in children under 6 and autoimmune diseases increasing thereafter. Careful examination and consideration of exposures can help identify infectious etiologies while abnormal findings may suggest alternative diagnoses.
This document discusses pyrexia of unknown origin (PUO). It defines PUO as a fever over 38°C lasting more than 3 weeks without an obvious cause despite evaluations. Common causes include infections (40%), malignancies (25%), and autoimmune diseases (15%). The document outlines the pathogenesis of fever and classifications of PUO. It describes the approach to evaluating a PUO patient through history, exam, and staged laboratory/imaging investigations. Empirical treatment trials are generally not recommended until a cause is found due to risks of misleading outcomes. The prognosis is determined by the underlying disease, with neoplasms having the worst outcomes.
This document discusses fever of unknown origin (FUO). It begins by classifying FUO into categories like classical FUO and nosocomial FUO. It then discusses the epidemiology and common etiologies of FUO, which include infections, collagen vascular diseases, and malignancies. The diagnostic approach involves a thorough history, repeated physical exams, and diagnostic testing like blood tests, imaging, and biopsies. Empirical therapeutic drug trials can help diagnose certain conditions but have limitations. The prognosis depends on the underlying cause, with poorer outcomes seen in elderly patients or those with neoplasms or diagnostic delays.
Approach to a patient with fever of unknown origin sunil kumar daha
Please find the power point on Approach to a patient with fever of unknown origin . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
1. Fever of unknown origin (FUO) is defined as a fever over 38.3°C for more than 3 weeks without a diagnosis after 1 week of investigation.
2. There are four main classifications of FUO: classic FUO, nosocomial FUO, neutropenic FUO, and HIV-associated FUO.
3. Infections, neoplasms, and noninfectious inflammatory diseases are the most common causes of classic FUO in adults, with tuberculosis, typhoid fever, and malaria among the leading infectious causes.
This document discusses acute rheumatic fever, an inflammatory disorder caused by an untreated Group A streptococcal infection. It is characterized by an inflammatory lesion of the connective tissues, especially the heart, joints, blood vessels, and skin. The main manifestations include carditis, arthritis, chorea, erythema marginatum, and subcutaneous nodules. The pathogenesis involves an autoimmune response triggered by the streptococcal infection that results in damage to connective tissues. Diagnosis is based on the Jones criteria of major and minor manifestations along with evidence of a prior streptococcal infection. Complications can include permanent cardiac damage if carditis is not properly treated.
This document discusses several pediatric infectious diseases that present with fever and rash: measles, rubella, varicella, and hand, foot and mouth disease. It provides details on the causative agents, clinical manifestations, investigations, treatment, prevention, and complications of each disease. A case scenario is also presented describing a 9-month-old girl presenting with fever, rash, cough and conjunctivitis consistent with measles. Differential diagnoses and distinguishing features between measles and rubella are also summarized.
Atypical pneumonia is caused by certain bacteria including Mycoplasma pneumoniae, Chlamydia pneumoniae, Chlamydia psittaci, and Legionella pneumophila. It tends to cause milder symptoms than typical pneumonia and does not usually require hospitalization. Different antibiotics are required to treat atypical versus typical pneumonia. Common symptoms include a persistent cough, headache, and low-grade fever.
This document discusses fever of unknown origin (FUO) in children. It defines FUO as a fever over 38°C that cannot be explained after 3 weeks of outpatient evaluation or 1 week of inpatient evaluation. Potential causes are divided into infectious and non-infectious categories. A thorough history, physical exam, and targeted investigations are important to identify the cause. Based on patient location and immune status, FUO can be further classified as classic, healthcare-associated, immune deficient, or HIV-related FUO. The most common causes vary according to these classifications.
This document discusses pyrexia of unknown origin (PUO), defined as a fever over 101°F persisting for more than 3 weeks without a confirmed diagnosis. It outlines the approach to evaluating a patient with PUO, including a thorough medical history and physical examination. Potential causes of PUO are grouped into infections, neoplastic diseases, autoimmune diseases, hereditary diseases, granulomatous diseases, and drug reactions. Common infectious causes include viral infections, tuberculosis, and bacterial infections like endocarditis.
This document discusses fever with rash and provides details on various conditions that can cause fever and rash. It describes the causes of fever as being pyrogens produced during infection or inflammation. Rash is described as being caused by infectious organisms multiplying in the skin, toxins acting on skin, autoimmune destruction, or vasculature involvement. Several conditions are then discussed in detail, including their causative agents, hosts, modes of transmission, symptoms, rashes, complications, diagnoses, and treatments. These conditions include measles, rubella, erythema infectiosum, roseola, infectious mononucleosis, primary HIV infection, and epidemic typhus.
NEPHRITIC SYNDROME / APSGN IN CHILDREN Sajjad Sabir
This document provides information about Acute Poststreptococcal Glomerulonephritis (APSGN). It begins by describing the features of acute nephritic syndrome which is characterized by gross hematuria, edema, hypertension, and renal insufficiency. It then discusses the pathology, clinical manifestations, diagnosis, and management of APSGN. APSGN is caused by a previous streptococcal infection and results in immune complex deposition in the glomeruli. It presents abruptly with hematuria, edema, hypertension, and sometimes renal insufficiency. Treatment focuses on supporting kidney function and controlling blood pressure while the patient recovers over 6-8 weeks. Prognosis is generally good with complete recovery in over 95
Contains 17 clinical situations of prolonged fever and discussion of various differential diagnosis based on them. Also gives the key points in the diagnosis of a prototype diagnosis and the usefulness of a relevant investigation modality in identifying these conditions. This power point presentaion is based on the chapter in Harrison's Text Book on Internal Medicine chapter on Fever of Unknown Origin
is an upper respiratory tract bacterial infection associated with a characteristic rash, which is caused by an infection with pyrogenic exotoxin (erythrogenic toxin) -producing GAS in individuals who do not have antitoxin antibodies In the past.
scarlet fever was thought to reflect infection of an individual lacking toxin-specific immunity with a toxin-producing strain of GAS.
Subsequent studies have suggested that development of the scarlet fever rash may reflect a hypersensitivity reaction requiring prior exposure to the toxin.
This document discusses pyrexia of unknown origin (PUO), also known as fever of unknown origin (FUO). It provides definitions of PUO, outlines the normal human body temperature, and categorizes different types of PUO including classical, nosocomial, neutropenic, HIV-associated, and transplant-associated PUO. It also discusses common causes of PUO including infections, malignancies, and collagen vascular diseases. The document emphasizes the importance of a thorough history and physical examination to identify potential etiologies and key physical signs.
Approach to history taking in a patient with feverReina Ramesh
The document provides an overview of fever (pyrexia), including its definition, pathophysiology, types, and differential diagnosis. It discusses how fever is regulated by the hypothalamus and the role of pyrogens and cytokines in initiating the febrile response. Common causes of fever are described, such as infections, malignancies, and autoimmune conditions. Different patterns of fever are also outlined, including continuous, intermittent, and remittent fever. The evaluation of pyrexia of unknown origin is summarized. Factitious fever is defined as fever intentionally fabricated by the patient. The importance of a thorough history is emphasized when evaluating a febrile patient.
Chronic viral hepatitis can be caused by hepatitis B virus (HBV), hepatitis C virus (HCV), or hepatitis D virus (HDV). HBV is responsible for 60-80% of hepatocellular carcinoma worldwide. HCV infection is the most common chronic blood-borne infection and a leading cause of cirrhosis and liver cancer. HDV requires HBV coinfection and can cause a more severe form of hepatitis. Treatment for chronic HBV and HCV infection involves antiviral medications like interferons, nucleoside analogs, and nucleotide analogs to achieve viral suppression and prevent disease progression.
This document provides information on viral exanthems, including goals of recognizing a morbilliform rash and describing presentations of childhood viral exanthems. It defines exanthem and enanthem rashes and describes morbilliform rashes as composed of erythematous macules and papules resembling measles. Classic childhood exanthems are described as measles, scarlet fever, rubella, roseola, and erythema infectiosum. Two case studies are presented - one involving a child with Koplik spots and a rash consistent with measles, and another involving an unvaccinated adult woman with a rash consistent with rubella.
The lecture gives concise review about the main four groups of viruses causing hemorrhagic fever i.e. Flavivirues, Filoviruses, Arenaviruses and Bunyaviruses.
1. Pyrexia of unknown origin (PUO) is defined as a fever that persists for at least 3 weeks with an unknown source despite 1 week of inpatient investigations or 3 outpatient visits. (2) Common causes of PUO include infections (especially tuberculosis), malignancies, and collagen vascular diseases.
2. A thorough history, physical exam, and initial laboratory and imaging tests are used to identify potential sources and guide further testing. Additional tests may include lumbar puncture, bone marrow biopsy, liver biopsy, or exploratory laparotomy.
3. When the source remains unknown after extensive evaluation, infectious disease, rheumatology, or oncology consultations may help identify less common causes or guide further
Clinical Approach To Aseptic Meningitis and Encephalitis
Virology Rotation (R2) , Clinical Microbiology Residency
King Fahd Hospital of The University
23/4/2019
This document discusses cerebral malaria, beginning with its definition as an unarousable coma caused by Plasmodium falciparum infection. It then covers the disease's epidemiology, noting it causes 300-500 million cases and over 1 million deaths annually worldwide, especially in Africa. The pathophysiology section explores the mechanical hypothesis of sequestration and rosetting of infected red blood cells in the brain vasculature and the toxin/cytokine hypothesis of an inflammatory response. Clinical features include seizures, altered consciousness, and possible neurological deficits upon recovery. Diagnosis relies on blood smears identifying the parasite, and treatment involves intensive care, antimalarial drugs like artesunate, and supportive care.
The document discusses bacterial meningitis, providing information on the anatomy of the meninges, causes of meningitis including bacterial, viral and fungal infections. It describes the typical presentation of bacterial meningitis including symptoms like headache, fever and neck stiffness. Complications are outlined such as subdural effusions, ependymitis and hydrocephalus. Causative organisms and their prevalence are summarized for different age groups.
1. Aplastic anemia is a condition characterized by pancytopenia (low red blood cells, white blood cells, and platelets) due to bone marrow failure.
2. It can be caused by exposure to toxins, radiation, viruses, or immune system attacks on the bone marrow. The bone marrow is hypocellular with fatty replacement of hematopoietic tissue.
3. Symptoms include anemia, increased risk of infection, bruising/bleeding due to low blood cell counts. Diagnosis involves blood tests showing pancytopenia and a bone marrow biopsy revealing a hypocellular marrow. Treatment options include supportive care, immunosuppressants, bone marrow transplant, or androgens
Dr. W.A.P.S.R.Weerarathna defines pyrexia of unknown origin (PUO) as a temperature of ≥ 38.3°C on multiple occasions for ≥ 3 weeks without reaching a diagnosis. Common causes of PUO include infections (40%), malignancies (25%), and autoimmune diseases (15%). For classic PUO, the three most common etiologies are infections, malignancies, and collagen vascular diseases. A thorough history, physical exam, and initial laboratory/imaging tests are recommended to guide further targeted investigations. More invasive testing should only be done if indicated or if initial evaluation does not identify the source of fever.
1. Pyrexia of unknown origin (PUO) is defined as a fever that persists for at least 3 weeks with an unknown source despite 1 week of inpatient investigations or 3 outpatient visits. (2) Common causes of PUO include infections (especially tuberculosis), malignancies, and collagen vascular diseases.
2. A thorough history, physical exam, and initial laboratory and imaging tests are used to identify potential sources and guide further testing. Additional tests may include lumbar puncture, bone marrow biopsy, liver biopsy, or exploratory laparotomy.
3. When the source remains unknown after extensive evaluation, infectious disease, rheumatology, or oncology consultations may help identify less common causes or guide further
This document discusses acute rheumatic fever, an inflammatory disorder caused by an untreated Group A streptococcal infection. It is characterized by an inflammatory lesion of the connective tissues, especially the heart, joints, blood vessels, and skin. The main manifestations include carditis, arthritis, chorea, erythema marginatum, and subcutaneous nodules. The pathogenesis involves an autoimmune response triggered by the streptococcal infection that results in damage to connective tissues. Diagnosis is based on the Jones criteria of major and minor manifestations along with evidence of a prior streptococcal infection. Complications can include permanent cardiac damage if carditis is not properly treated.
This document discusses several pediatric infectious diseases that present with fever and rash: measles, rubella, varicella, and hand, foot and mouth disease. It provides details on the causative agents, clinical manifestations, investigations, treatment, prevention, and complications of each disease. A case scenario is also presented describing a 9-month-old girl presenting with fever, rash, cough and conjunctivitis consistent with measles. Differential diagnoses and distinguishing features between measles and rubella are also summarized.
Atypical pneumonia is caused by certain bacteria including Mycoplasma pneumoniae, Chlamydia pneumoniae, Chlamydia psittaci, and Legionella pneumophila. It tends to cause milder symptoms than typical pneumonia and does not usually require hospitalization. Different antibiotics are required to treat atypical versus typical pneumonia. Common symptoms include a persistent cough, headache, and low-grade fever.
This document discusses fever of unknown origin (FUO) in children. It defines FUO as a fever over 38°C that cannot be explained after 3 weeks of outpatient evaluation or 1 week of inpatient evaluation. Potential causes are divided into infectious and non-infectious categories. A thorough history, physical exam, and targeted investigations are important to identify the cause. Based on patient location and immune status, FUO can be further classified as classic, healthcare-associated, immune deficient, or HIV-related FUO. The most common causes vary according to these classifications.
This document discusses pyrexia of unknown origin (PUO), defined as a fever over 101°F persisting for more than 3 weeks without a confirmed diagnosis. It outlines the approach to evaluating a patient with PUO, including a thorough medical history and physical examination. Potential causes of PUO are grouped into infections, neoplastic diseases, autoimmune diseases, hereditary diseases, granulomatous diseases, and drug reactions. Common infectious causes include viral infections, tuberculosis, and bacterial infections like endocarditis.
This document discusses fever with rash and provides details on various conditions that can cause fever and rash. It describes the causes of fever as being pyrogens produced during infection or inflammation. Rash is described as being caused by infectious organisms multiplying in the skin, toxins acting on skin, autoimmune destruction, or vasculature involvement. Several conditions are then discussed in detail, including their causative agents, hosts, modes of transmission, symptoms, rashes, complications, diagnoses, and treatments. These conditions include measles, rubella, erythema infectiosum, roseola, infectious mononucleosis, primary HIV infection, and epidemic typhus.
NEPHRITIC SYNDROME / APSGN IN CHILDREN Sajjad Sabir
This document provides information about Acute Poststreptococcal Glomerulonephritis (APSGN). It begins by describing the features of acute nephritic syndrome which is characterized by gross hematuria, edema, hypertension, and renal insufficiency. It then discusses the pathology, clinical manifestations, diagnosis, and management of APSGN. APSGN is caused by a previous streptococcal infection and results in immune complex deposition in the glomeruli. It presents abruptly with hematuria, edema, hypertension, and sometimes renal insufficiency. Treatment focuses on supporting kidney function and controlling blood pressure while the patient recovers over 6-8 weeks. Prognosis is generally good with complete recovery in over 95
Contains 17 clinical situations of prolonged fever and discussion of various differential diagnosis based on them. Also gives the key points in the diagnosis of a prototype diagnosis and the usefulness of a relevant investigation modality in identifying these conditions. This power point presentaion is based on the chapter in Harrison's Text Book on Internal Medicine chapter on Fever of Unknown Origin
is an upper respiratory tract bacterial infection associated with a characteristic rash, which is caused by an infection with pyrogenic exotoxin (erythrogenic toxin) -producing GAS in individuals who do not have antitoxin antibodies In the past.
scarlet fever was thought to reflect infection of an individual lacking toxin-specific immunity with a toxin-producing strain of GAS.
Subsequent studies have suggested that development of the scarlet fever rash may reflect a hypersensitivity reaction requiring prior exposure to the toxin.
This document discusses pyrexia of unknown origin (PUO), also known as fever of unknown origin (FUO). It provides definitions of PUO, outlines the normal human body temperature, and categorizes different types of PUO including classical, nosocomial, neutropenic, HIV-associated, and transplant-associated PUO. It also discusses common causes of PUO including infections, malignancies, and collagen vascular diseases. The document emphasizes the importance of a thorough history and physical examination to identify potential etiologies and key physical signs.
Approach to history taking in a patient with feverReina Ramesh
The document provides an overview of fever (pyrexia), including its definition, pathophysiology, types, and differential diagnosis. It discusses how fever is regulated by the hypothalamus and the role of pyrogens and cytokines in initiating the febrile response. Common causes of fever are described, such as infections, malignancies, and autoimmune conditions. Different patterns of fever are also outlined, including continuous, intermittent, and remittent fever. The evaluation of pyrexia of unknown origin is summarized. Factitious fever is defined as fever intentionally fabricated by the patient. The importance of a thorough history is emphasized when evaluating a febrile patient.
Chronic viral hepatitis can be caused by hepatitis B virus (HBV), hepatitis C virus (HCV), or hepatitis D virus (HDV). HBV is responsible for 60-80% of hepatocellular carcinoma worldwide. HCV infection is the most common chronic blood-borne infection and a leading cause of cirrhosis and liver cancer. HDV requires HBV coinfection and can cause a more severe form of hepatitis. Treatment for chronic HBV and HCV infection involves antiviral medications like interferons, nucleoside analogs, and nucleotide analogs to achieve viral suppression and prevent disease progression.
This document provides information on viral exanthems, including goals of recognizing a morbilliform rash and describing presentations of childhood viral exanthems. It defines exanthem and enanthem rashes and describes morbilliform rashes as composed of erythematous macules and papules resembling measles. Classic childhood exanthems are described as measles, scarlet fever, rubella, roseola, and erythema infectiosum. Two case studies are presented - one involving a child with Koplik spots and a rash consistent with measles, and another involving an unvaccinated adult woman with a rash consistent with rubella.
The lecture gives concise review about the main four groups of viruses causing hemorrhagic fever i.e. Flavivirues, Filoviruses, Arenaviruses and Bunyaviruses.
1. Pyrexia of unknown origin (PUO) is defined as a fever that persists for at least 3 weeks with an unknown source despite 1 week of inpatient investigations or 3 outpatient visits. (2) Common causes of PUO include infections (especially tuberculosis), malignancies, and collagen vascular diseases.
2. A thorough history, physical exam, and initial laboratory and imaging tests are used to identify potential sources and guide further testing. Additional tests may include lumbar puncture, bone marrow biopsy, liver biopsy, or exploratory laparotomy.
3. When the source remains unknown after extensive evaluation, infectious disease, rheumatology, or oncology consultations may help identify less common causes or guide further
Clinical Approach To Aseptic Meningitis and Encephalitis
Virology Rotation (R2) , Clinical Microbiology Residency
King Fahd Hospital of The University
23/4/2019
This document discusses cerebral malaria, beginning with its definition as an unarousable coma caused by Plasmodium falciparum infection. It then covers the disease's epidemiology, noting it causes 300-500 million cases and over 1 million deaths annually worldwide, especially in Africa. The pathophysiology section explores the mechanical hypothesis of sequestration and rosetting of infected red blood cells in the brain vasculature and the toxin/cytokine hypothesis of an inflammatory response. Clinical features include seizures, altered consciousness, and possible neurological deficits upon recovery. Diagnosis relies on blood smears identifying the parasite, and treatment involves intensive care, antimalarial drugs like artesunate, and supportive care.
The document discusses bacterial meningitis, providing information on the anatomy of the meninges, causes of meningitis including bacterial, viral and fungal infections. It describes the typical presentation of bacterial meningitis including symptoms like headache, fever and neck stiffness. Complications are outlined such as subdural effusions, ependymitis and hydrocephalus. Causative organisms and their prevalence are summarized for different age groups.
1. Aplastic anemia is a condition characterized by pancytopenia (low red blood cells, white blood cells, and platelets) due to bone marrow failure.
2. It can be caused by exposure to toxins, radiation, viruses, or immune system attacks on the bone marrow. The bone marrow is hypocellular with fatty replacement of hematopoietic tissue.
3. Symptoms include anemia, increased risk of infection, bruising/bleeding due to low blood cell counts. Diagnosis involves blood tests showing pancytopenia and a bone marrow biopsy revealing a hypocellular marrow. Treatment options include supportive care, immunosuppressants, bone marrow transplant, or androgens
Dr. W.A.P.S.R.Weerarathna defines pyrexia of unknown origin (PUO) as a temperature of ≥ 38.3°C on multiple occasions for ≥ 3 weeks without reaching a diagnosis. Common causes of PUO include infections (40%), malignancies (25%), and autoimmune diseases (15%). For classic PUO, the three most common etiologies are infections, malignancies, and collagen vascular diseases. A thorough history, physical exam, and initial laboratory/imaging tests are recommended to guide further targeted investigations. More invasive testing should only be done if indicated or if initial evaluation does not identify the source of fever.
1. Pyrexia of unknown origin (PUO) is defined as a fever that persists for at least 3 weeks with an unknown source despite 1 week of inpatient investigations or 3 outpatient visits. (2) Common causes of PUO include infections (especially tuberculosis), malignancies, and collagen vascular diseases.
2. A thorough history, physical exam, and initial laboratory and imaging tests are used to identify potential sources and guide further testing. Additional tests may include lumbar puncture, bone marrow biopsy, liver biopsy, or exploratory laparotomy.
3. When the source remains unknown after extensive evaluation, infectious disease, rheumatology, or oncology consultations may help identify less common causes or guide further
This document discusses fever of unknown origin (FUO). It categorizes FUO into classical, nosocomial, neutropenic, and HIV-associated types. The most common etiologies of FUO are infections (30-60%), collagen vascular diseases (20-35%), and malignancies (10-20%). The diagnostic approach involves a careful history, physical exam, and diagnostic testing including blood tests, imaging, and biopsy. Empirical therapeutic drug trials may be used for suspected conditions like tuberculosis or culture-negative endocarditis, but have limitations and risks. The goal is to reach a specific diagnosis to guide appropriate treatment.
The document discusses the evaluation and diagnosis of pyrexia of unknown origin (PUO). It defines PUO and provides classifications. The most common causes are infections (30-40%), neoplasms (20-30%), and non-infectious inflammatory conditions (10-20%). The initial approach involves thorough history, physical exam, and basic lab tests. Further targeted testing is based on clues from initial evaluation and may include specialized cultures, biopsies, and imaging. The goal is to methodically consider and rule out more likely causes through an intensive diagnostic process to identify the underlying condition.
Infective Endocarditis is a microbial infection of the heart valves or inner lining of the heart. It is most commonly caused by bacteria and can lead to the formation of vegetations on the heart valves. The diagnosis is based on the modified Duke criteria which incorporates blood culture results, echocardiography findings and clinical features such as fever, heart murmur and embolic phenomena. Early diagnosis is important to guide treatment, which typically involves prolonged intravenous antibiotics.
Here are the key types of fever patterns:
a) Continuous fever - Fever persists continuously without significant variation in temperature. Seen in conditions like tuberculosis, bacterial endocarditis.
b) Intermittent fever - Fever with abrupt onset and remission, such as in malaria. Temperature spikes occur at regular intervals.
c) Remittent fever - Fever that decreases but does not return to normal. The temperature remains elevated between peaks, such as in typhoid fever.
The document discusses symptomatology and fever of unknown origin (PUO). It notes that symptomatology refers to a patient's symptoms and signs. PUO is defined as fever that is unexplained after three outpatient visits or three days of investigation in the hospital. Common causes of PUO include infections, malignancies, and collagen vascular diseases. A thorough history, physical exam, and basic diagnostic tests are important for evaluating PUO.
This presentation focuses on the entity known as pyrexia of unknown origin / fever of unknown origin. It demonstrates both common and rare causes, and the epidemiological trend, its clinical presentation, management and prognosis.
Diagnosis and managment of Fever of Unknown Originarahmanzai5
Fever of unknown origin (FUO) is defined as a fever over 38.3°C on at least two occasions lasting more than 3 weeks without a diagnosis. Common causes include infections such as endocarditis, malignancies such as lymphoma, and autoimmune disorders. The evaluation involves blood tests, imaging, and cultures to rule out common causes. If the cause remains unknown after initial testing, more invasive procedures like biopsy may be considered. Empiric treatment is generally avoided due to the risk of masking the underlying diagnosis, but may be considered in rapidly deteriorating patients. The prognosis is generally good, with most cases ultimately receiving a diagnosis and treatment.
This document provides an overview and schedule for the PLE Board Exam Review in 2023. The review will take place on March 12, 2023 and cover topics including IDS/communicable diseases, pulmonology, gastroenterology, and rheumatology. Each topic is allotted a specific time block and there are breaks scheduled between sections. The review also includes sample questions related to various diseases like leptospirosis, typhoid, tetanus, and others.
This document provides information on fever in infants and children, including:
1) It describes the differences between true fever caused by the body's set point being increased due to infection or inflammation, versus false fever which does not directly increase the set point.
2) Evaluation of the febrile infant or child involves obtaining a thorough history, physical exam, and screening tests like CBC, blood cultures, and lumbar puncture if meningitis is suspected, to identify potential causes and focus of infection.
3) Management depends on the age of the child. Neonates less than 1 month require full sepsis workup and antibiotics if febrile. Infants 1-3 months can potentially be treated as out
The document discusses fever of unknown origin (FUO). It defines FUO as a fever over 38.3°C on two occasions that lasts longer than 3 weeks and where the cause is not determined after a week of testing. Common causes include infections like tuberculosis, inflammatory diseases, and cancers. The document outlines different categories of FUO and discusses approaches to evaluating potential causes based on factors like location of fever onset and patient immune status. It also lists specific conditions that commonly underlie FUO and notes their distinguishing features.
This document discusses fever of unknown origin (FUO), providing criteria for FUO, potential etiologies including infections, malignancies, and miscellaneous causes. It describes the characteristic history, physical exam findings, and key nonspecific test abnormalities that form the basis for a focused workup of FUO. Specific patient populations like those with HIV, solid organ transplants, or who have traveled are also discussed. The document concludes with considerations for therapy in FUO cases until a definite diagnosis can be made.
This document discusses pyrexia of unknown origin (PUO), defined as a fever above 38°C for more than 3 weeks without diagnosis. Common causes include infections (30%), malignancy (20%), and connective tissue disorders (15%). The document outlines an approach to evaluating PUO that involves obtaining a thorough history, conducting a physical exam focusing on potentially diagnostic clues, and performing initial obligatory tests before considering additional guided diagnostic tests if needed. Treatment is typically supportive while the underlying cause is determined. The overall mortality rate is high at 30-40% mainly due to malignancy, though fever often resolves spontaneously if no cause is found.
This document discusses myocarditis and pericarditis. It begins by describing the objectives of explaining the epidemiology, risk factors, pathogenesis, types, etiological agents, clinical presentation, diagnosis, and management of myocarditis and pericarditis. It then provides details on the definition, causes, clinical presentation and diagnosis of myocarditis. It also discusses the definition, types, pathophysiology, clinical presentation, differential diagnosis, investigations and management of pericarditis. It highlights that viral infections are a common cause of both conditions.
A case presentation and discussion of TB Meningitis presented in a Tertiary Care Hospital ER. Includes presenting complaints, work-up, diagnosis and relevant case discussion.
This document discusses persistent fevers in non-tropical patients and provides details on evaluating and diagnosing the underlying cause. It begins by defining different fever patterns and then lists potential infectious and non-infectious causes of persistent fever organized by organ system or disease category. Basic screening tests are recommended to help guide diagnosis. The challenges of diagnosing tropical illnesses in returning travelers are also addressed.
1. Prolonged unexplained fever (PUO) is defined as a fever above 38.3°C for at least 3 weeks without a confirmed diagnosis after outpatient visits or 3 days of hospitalization.
2. Infections are the most common cause of PUO (45% of cases), followed by malignancy (20%) and connective tissue diseases (15%).
3. Common infectious causes include tuberculosis, endocarditis, hepatitis, and infections of the abdomen, urinary tract, bones/joints, and dental/sinus areas. Viral, bacterial, fungal, and parasitic infections can also cause PUO.
This document discusses lymphadenopathy and provides information about evaluating and diagnosing causes of lymphadenopathy. It begins by defining lymphadenopathy and describing classifications such as localized versus generalized. For patients presenting with unexplained lymphadenopathy, approximately 3/4 will have localized lymphadenopathy while 1/4 will have generalized. The document then discusses evaluating the history, performing a physical exam, potential causes of lymphadenopathy, and guidelines for biopsy of localized versus generalized lymphadenopathy. It also provides a case study of a patient, M.S., who presented with lymphadenopathy and was ultimately diagnosed with Stage IIB nodular sclerosis Hodgkin's lymphoma.
This document discusses standardization of urinalysis, including specimen collection, preservation, and analysis techniques. It covers macroscopic examination of urine volume, appearance, odor, and color. Chemical analysis includes dipstick testing for glucose, bilirubin, ketones, specific gravity, blood, pH, protein, urobilinogen, nitrite, and leukocyte esterase. Microscopic examination standards are provided for cells, casts, crystals, bacteria, and yeast seen in urine sediment. Automated urine analyzers are also discussed. Standardization is important for uniformity and accurate interpretation of urinalysis results.
The document discusses several pre-leukemic disorders and congenital defects that can progress to acute myeloid leukemia (AML) if not treated. These include myelodysplastic syndrome (MDS), marrow failure syndromes like aplastic anemia, and genetic conditions like Fanconi anemia, dyskeratosis congenita, and Shwachman-Diamond syndrome. MDS is characterized by dysplastic and ineffective hematopoiesis leading to cytopenias. Fanconi anemia results from a DNA repair defect and patients have a high risk of developing AML. Dyskeratosis congenita causes bone marrow failure below age 20 due to telomere dysfunction. Treatment options discussed include hematopoietic
IgG4-related disease is a newly recognized fibro-inflammatory condition that can affect many organs. It is characterized by tumefactive lesions, elevated serum IgG4 concentrations, and distinctive histopathological features including dense storiform fibrosis, obliterative phlebitis, and lymphoplasmacytic infiltration with IgG4-positive plasma cells. It involves a modified Th2 immune response and affects multiple organ systems. Diagnosis requires characteristic histopathological findings as well as clinical features and elevated serum IgG4 levels. Treatment involves corticosteroids and plasmapheresis.
This document defines and describes various pathological processes including degeneration, necrosis, apoptosis, gangrene, and calcification. It discusses four main types of degenerative cell changes: cellular swelling, fatty change, hyaline change, and mucoid change. It also describes five types of necrosis: coagulative, liquefactive, caseous, fat, and fibrinoid necrosis. Apoptosis is defined as a genetically programmed form of cell death. Gangrene is described as necrosis with superadded putrefaction. Pathologic calcification can be either dystrophic or metastatic.
This document discusses the four main types of hypersensitivity reactions:
Type I is an IgE-mediated allergic reaction involving mast cells. Type II involves antibody-mediated cytotoxicity through complement activation or ADCC. Type III is an immune complex-mediated reaction where circulating immune complexes deposit in tissues. Type IV is a cell-mediated delayed type hypersensitivity reaction involving sensitized T cells. Each type has different mechanisms of tissue damage and clinical manifestations ranging from localized reactions to generalized conditions like serum sickness.
This document outlines the histotechnique process which tissues undergo before microscopic examination. Key steps include: fixation to preserve tissue structure; processing involving dehydration, clearing, and impregnation to allow sectioning; embedding tissues in paraffin blocks for microtomy; sectioning samples and staining, typically with hematoxylin and eosin, for visualization under the microscope. Finally, samples are mounted on slides and labeled for storage and pathological examination.
This document discusses fungal infections in histopathology. It provides advantages of histopathology for fungal identification, describes special staining techniques used to identify fungi in different tissues, outlines major fungal forms seen, and lists true and opportunistic fungal pathogens. It also describes 8 cases presenting with fungal infections and provides the diagnoses for each case. The document serves as a reference for histopathologists to identify fungi in tissue samples.
Fungal infections can be caused by molds, yeasts, or dimorphic fungi. Molds like Aspergillus form hyphae and reproduce asexually via spores. Yeasts like Candida are single-celled and reproduce by budding. Dimorphic fungi can exist as molds or yeasts depending on temperature. Common fungal infections include candidiasis, aspergillosis, cryptococcosis, and mucormycosis. Candida normally lives on the skin and mucosal surfaces but can cause infections like oral thrush in immunocompromised individuals. Aspergillosis primarily affects the lungs and causes pneumonia in those with weak immune systems.
This document describes diseases of blood vessels. It begins by describing the basic structure and types of blood vessels. It then discusses various pathologies that can affect blood vessels including congenital anomalies, arteriosclerosis, hypertension, vasculitides, aneurysms, dissections, problems with veins and lymphatics, and tumors. Specific conditions discussed in more detail include abdominal aortic aneurysms, thoracic aortic aneurysms, berry aneurysms, aortic dissections, varicose veins, and various vasculitides such as Takayasu arteritis, polyarteritis nodosa, Kawasaki disease, Wegener's granulomatosis, microscopic polyangiitis, and Churg-Strauss
This document summarizes coagulation studies and disorders. It discusses the physiological clotting mechanism including the intrinsic, extrinsic, and common pathways. Common coagulation tests like prothrombin time, activated partial thromboplastin time, bleeding time, and mixing studies are outlined. Inherited disorders like hemophilia A and B and acquired disorders such as liver disease, vitamin K deficiency, and disseminated intravascular coagulation are summarized. The roles of natural coagulation inhibitors and how their deficiencies can cause hypercoagulable states are also highlighted.
This document discusses cerebrovascular diseases and provides details on various types:
1. It describes cerebrovascular disease as any abnormality of the brain caused by blood vessels, including thrombosis, embolism, and hemorrhage.
2. Stroke is defined as a sudden neurological deficit due to a vascular impairment, which is a common cause of death in the US.
3. Details are given on global cerebral ischemia from reduced blood flow and focal ischemia from localized vessel obstruction.
This document summarizes different types of blood products including whole blood, red blood cell concentrates, platelet concentrates, fresh frozen plasma, and cryoprecipitate. It describes the components, storage requirements, quality control parameters, and indications/contraindications for each product. It also discusses leukodepletion of blood products and protocols to ensure the safety of blood transfusions.
1) Blood components like packed red cells, platelet concentrates and fresh frozen plasma can be prepared by separating whole blood into its components using centrifugation and expressors.
2) Optimal storage conditions and times allow individual components to be stored and transfused separately as needed rather than transfusing whole blood.
3) The document outlines the equipment, procedures and quality indicators for preparing the main blood components from a single donor to benefit multiple recipients.
The document summarizes key aspects of haemostasis including the vascular, platelet and coagulation phases. It describes tests used to diagnose bleeding disorders affecting platelets or coagulation factors. Managing dental procedures in patients with bleeding disorders requires modifying treatment based on the nature and severity of the disorder to minimize risks of bleeding. Pre-operative assessment of bleeding history and factors is important to guide management and prevent post-operative bleeding complications.
- Benign inclusions are non-neoplastic ectopic tissue found in lymph nodes that can originate from various sources such as paramesonephric ducts, salivary glands, breast tissue, thyroid follicles, and squamous or mesothelial cells.
- Common types include epithelial inclusions resembling ducts or cysts, nevomelanocytic aggregates in capsules, and decidual tissues. Precise classification and identification is important to differentiate from metastatic adenocarcinoma.
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Paneth cell metaplasia is seen in 31% of cases of Barrett's esophagus. It is more commonly seen in non-dysplastic Barrett's esophagus and Barrett's with indefinite or low-grade dysplasia. The presence of Paneth cell metaplasia is associated with less regression of Barrett's esophagus, though it does not increase risk of progression. Patients without Paneth cell metaplasia were three times more likely to experience regression of Barrett's esophagus.
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Immunohistochemistry (IHC) utilizes labeled antibodies to localize specific antigens in tissue sections through antigen-antibody interactions visualized by markers like fluorescent dyes or enzymes. IHC allows visualization of the distribution and localization of cellular components within tissues. The process involves raising antibodies to target antigens, labeling the antibodies, and applying them to tissue sections using techniques like direct, indirect, or peroxidase anti-peroxidase (PAP) methods. IHC is a sensitive and specific technique that is useful for cancer diagnosis and research applications.
Cytopathology is the study of exfoliated cells to detect normal and abnormal tissue morphology. Cells can be collected naturally or artificially from various body sites like skin, cervix, lungs, and lymph nodes. Cytopathology allows rapid, inexpensive diagnosis and monitoring of diseases without surgery. Pap smears screen for cervical cancer by examining cells from the cervix and vagina. Abnormal findings on Pap smears require follow up with colposcopy and possible biopsy. Screening reduces cervical cancer rates by facilitating early detection and treatment of precancerous lesions.
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2. Old Definition(Petersdorf and
Beeson 1961)
1. Fever higher than 38.3oC
on several occasions.
2. Duration of fever > 3
weeks
3. Uncertain diagnosis after
one week of study in
hospital
New Definition:(Durack and Street
1995)
1. Fever higher than 38.3oC on
several occasions.
2. Duration of fever > 3 weeks
3. → 3 outpatient visits, or 3
days in hospital without
elucidation of the cause or 1
week of “intelligent and
invasive” ambulatory
investigation
DEFINITION
3. NEW DEFINITION EXPANSION
1. Classical PUO
2. Nosocomial PUO
3. Neutropenic PUO
4. HIV-Associated
5. Transplant
4. Nosocomial PUO: in hospitalized patient who is receiving acute care
& in whom infection was not manifest or incubating on admission.3
days of investigation including at least 2 days incubation of cultures
minimum requirement
Neutropenic PUO: in patient whose neutrophil count<500/ul or is
expected to fall to that level in 1-2days.Diagnosis is invoked if specific
cause is not identified after 3 days of investigations including 2 days
incubation of cultures
HIV assoc PUO: Temp >38.3.c on several occasions over a period of
>4 weeks for outpatients or >3 days for hospitalized patients with HIV
infection. dx is invoked if appropriate inv over 3 days including 2 days
incubation of cultures reveals no source
14. ETIOLOGIES OF PUO
Infection
Tuberculosis: Disseminated
The single most common infection in most PUO series except
in children
Usually extrapulmonary or miliary
Occurs in the lungs when significant pre-existing lung disease.
Pul. TB in AIDS is often subtle (normal CXR in 15 – 30%).
PPD is +ve < 50% of TB with PUO.
Diagnosis often requires biopsy of LN/Liver/Bone marrow.
15. ETIOLOGIES OF PUO
Abscess:
Usually located in abdomen or pelvis.
Secondary to appendicitis or diverticulitis.
Pyogenic liver abscess usually follow biliary tract disease or
abdominal suppuration
Amoebic liver abscess is similar to pyogenic → amoebic
serology is positive > 95% of cases.(IHA,ELISA)
Splenic abscess is usually secondary to hematogenous
seeding.
Perinephric or renal abscess is usually secondary to UTI.
16. ETIOLOGIES OF PUO
Bacterial Endocarditis
Culture remains negative in 5% of patient.
Culture negative is likely with the following organisms:
Coxiella burnetii → no growth.
HACEK group → incubate blood 7 – 21 days,slow growing
Brucella } Special media
Legionella Long Time
Mycoplasm/Chlamydia
Fungal → usually sterile
Peripheral signs may not be detected.
Right-side endocarditis lack murmurs
17. ETIOLOGIES OF PUO
Malignancy
Lymphoma: Fever is a presenting feature
Leukemia: M. Myeloma (fever means infection)
Renal cell carcinoma: only rarely fever is there
HCC or secondary metastasis to the liver
18. ETIOLOGIES OF PUO
Lymphoma:
Fever is a well-recognized manifestation.
A Pel-Ebstein phenomenon is rare.
Source of fever : production of cytokines.
Fever is a negative prognostic factor
Renal Cell Carcinoma (Adult)
20% present with fever
Microscopic hematuria
19. ETIOLOGIES OF PUO
Wilms Tumor (Children)
Peak incidence 2-3 years.
Abdominal mass but FEVER can be a presentation.
Solid Tumor
Fever is rare except:
Secondary metastasis to the liver
Ductal obstruction or perforation like cholangioacarcinoma
or ampulla carcinoma
Lung carcinoma with obstruction and pneumonia.
20. ETIOLOGIES OF PUO
Collagen-Vascular-Disease
No diagnostic serology
The syndrome needs to be identified for diagnosis
Still’s disease (young or adult)
Giant cell arteritis } → 15% of PUO
Polymyalgia Rheumatica }
Behcet’s Disease
Relapsing polychondritis
21. ETIOLOGIES OF PUO
Adult Onset Still’s Disease
Age 16 – 35 with (-ve) RF & ANA
Fever is high and spiking with temp. up to 41.6oC (hectic)
Fever is either intermittent or remittent (peaks typically at night)
Most patient seek medical attention within 2 weeks.
A distinctive evanescent macular or papular rash is typically
present during the course of the illness.
Dx is strictly a clinical: RF is almost uniformly negative.
Other features: myalgias, arthritis, leukocytosis (neutrophils),
hepatosplenomegaly & lymphadenopathy.
high serum ferritin (> 2000)
22. ETIOLOGIES OF PUO
Temporal Arteritis:
Very serious condition if not diagnosed early
Very difficult to establish the etiology of fever without high index of
suspicion
Fever and malaise may be the only manifestation. Headache is
the most common.
Common cause of puo in elderly >70 yrs
Tenderness or decreased pulsation guide the selection of site of
bx
“blind biopsy” of one or both temporal arteries may yield to
diagnosis
23. ETIOLOGIES OF PUO
Polymyalgia Rheumatica:
Can cause fever, arthralgia, myalgia & ↑ ESR > 50.
Characteristic muscle complaints: symmetrical pain and stiffness
that are typically worse at morning
Affects lumbar spine and large proximal muscles
Other vasculitides that cause PUO:
Polyarteritis nodosa → Mononeuritis multiplex (60%)
Wegener’s Granulomatosis
Mixed Cryoglobulinemia
24. ETIOLOGIES OF PUO
Miscellaneous Causes: (Non-Infectious)
Vascular Causes:
Pulmonary Emboli
50% are febrile
Fever is characteristic (< 39oC)
Patient typically has predisposing factors : cancer or recent
immobility.
Hematoma in closed space
Hemorrhage in the retroperitoneal space
Within the wall of an aneurysm or dissection of the thoracic or
abdominal aorta.
25. ETIOLOGIES OF PUO
Factitious Fever
In a study 9% of cases of PUO were factitious
False fever:
Thermometer manipulation using external heat or substitute
thermometer.
Genuine fever (self induced)
Administration of pyrogenic substances (bacterial suspensions)
Generally young women with connection to health care often
NURSES.
26. It is axiomatic that as the duration of fever
increases, the likelihood of an infectious
cause decreases even for the more
indolent infections (brucellosis,
paracoccidiomycosis, etc.)
27. PYREXIA OF UNKNOWN ORIGIN
The majority of disease remaining after an initial NEGATIVE
workup are:
1. Neoplasm
2. Seronegative collagen vascular disease
3. Progressive Tuberculosis
4. Increasing Drug Addition
5. Elderly with Endocarditis
6. HIV with or without infection or malignancy
7. Prosthetic devices / implants
8. Travel
28. CLINICAL
History
Travel:
Travel to an area known to be endemic for certain disease:
Name of the area, duration of stay
Onset of illness (incubation period)
1 – 10 Days 10 – 21 Days Weeks - Months
Malaria Malaria Kala Azar
Plague Typhoid Amoebiasis
Dengue Brucella HIV
Salmonella Hepatitis A Hepatitis
EVALUATION OF PUO
29. Physical examination
Localizing Symptoms may Indicate the source of fever:
Back Pain TB Spondylitis
Bone Metastasis
Headache Chronic Meningitis/GCA
RUQ Pain Liver Abscess
LUQ Pain Splenic Abscess
Oral & Genital Ulcer Behcet’s Disease
Jaw Claudication Temporal Arteritis
Subtle changes in behavior Granulomatous Meningitis
EVALUATION OF PUO
30. ROLE OF LAB INVESTIGATIONS
MINIMAL DIAGNOSTIC CRITERIA
History & Physical
examination
CBC & DLC, TLC
U/A and Microscopy
Chest X-ray
Blood Cultures x 3
Urine culture
LFTs
Hepatitis serologies (if
abnormal LFTs)
Chem10
31. OTHER TESTS
ESR/CRP
Peripheral Smear
Anti Nuclear Antibody
Rheumatoid Factor
HIV
CMV IgM
Mono Spot
PPD
34. ROUTINE
↑ High ESR → lacks specificity:
Drug Reaction
Thrombophlebitis may cause very high ESR
Nephrotic Syndrome
Normal ESR → significant inflammatory process is absent with
exception.
CRP-level may be useful cross reference for ESR
More sensitive and specific indicator of an “acute
phase”inflammatory metabolic response.
35. MARKERS OF INFLAMMATION
Acute Phase Proteins
Proteins Increased Proteins Decreased
Fibronogen Albumin
Ferritin Transferrin
Plasminogen
Fetoprotein
Protein S
Ceruloplasmin
36. LAB EVALUATION
Blood Testing
Anti-nuclear Antibodies
Rheumatoid Factor
CMV Antibody: IgM
Heterophile Antibody Test in children and young adult
Thyroid Function Test
HIV Screening
Angiotensin converting enzyme
Febrile agglutinins
37. LAB EVALUATION
Cultures
Blood
Obtain more than 3 blood cultures from separate sites over 24 hr
period prior to antibiotics if Infective Endocarditis is suspected
Lysis centrifugation blood culture techniques
Sputum: For Tuberculosis
Any normal sterile: CSF/urine/pleural or peritoneal fluid
Bone marrow aspirate → Tuberculosis/Brucellosis
Lymph node aspirate → TB
38. Detection of mycobacterial agents
Stains
Carbol fuschin (classic ZN stain, cold Kinyoun stain)
Fluorochrome stain ( auramine-rhodamine & auramine O)
Culture
Broth culture: BACTEC 460TB,SEPTI-CHEK AFB
Solid medium-: LJ;Middlebrook 7H10,7H11
Currently most rapid method: nucleic acid amplification test
Amplified mycobacteriym TB direct test (Gen Probe)
AMLICOR mycobacterium tuberculosis test (Roche)
40. OTHER INVESTIGATION
Imaging Studies: to localize abnormalities for definite tests or
treatment
Chest x-ray:
Miliary shadows → disseminated tuberculosis
Atelectasis
↑ Hemi diaphragm
Pleural Effusion
Mediastinal mass → Lymphoma/Tuberculosis/ Sarcoid
If CXR is WNL → Repeat on weekly basis
Ultra sonography
Hepatic, Splenic, Pancreatic or
Subphrenic Abcess
41. IMAGING STUDIES
CT-Scan → CT scan chest
Mediastinal mass → Tuberculosis/Lymphoma/ Sarcoidosis
Dorsal Spine → Spondylitis and disc space disease
CT-Scan Abdomen → very effective to visualize
All types of abscesses
Retroperitoneal tumor, lymph node or haematoma
MRI: spleen, lymph node and the brain
42. Radionuclear Scanning
Bone TC-scan → osteomyelitis (skeletal),bony metastasis
Gallium scan → occult inflammation, pneumocystis
Indium labeled WBC-scan → occult abscesses
Fluorodeoxyglucose F18(FDG)PET scanning appears to be
superior to other forms of nuclear imaging
FDG used in PET scans accumulates in tumour and at sites of
inflammation
NEWER TECHNIQUES
43. A radiograph of the right humerus (a part of skeletal survey) shows no
abnormality in a 69-year-old man recently diagnosed with multiple
myeloma.
FDG-PET shows
multiple areas of
hypermetabolism,
including in the right
humerus where the
radiograph was negative.
The majority of lesions in
the ribs, scapulae and
spine are not visualized
on the skeletal survey.
44. RADIONUCLEAR STUDIES
Radionuclear Scanning
Overall Assessment:
Non-specific tests to localize a site for more specific
evaluation (such as CT-scan)
Impressive no. of false (+) and false (-) results
True positive scan only indicates an area of increased
uptake → no anatomic detail
45. GALLIUM SCAN
Will be hot if there is:
Increased blood flow
Uptake by bacteria (lactoferrin)
Uptake by WBC
Sensitive but not specific
Not recommended for abdomen or pelvis: false +ves are common
Effective in:
Chronic Infection
Lymphoma
46. INDIUM-LABELED LEUKOCYTE
Uptake by WBC
Only for acute problem (less than 4 weeks)
Study in the UK has found the sensitivity for infective PUO: 25%
and specificity was 100%
Recommended for strongly suspected infective PUO if done within
the 1st 2-4 weeks
False positive: post op wound, mastitis
Retroperitoneal angiosarcoma demonstrating mild uptake of
In111-WBC.
47. Laparoscopy
To visualize and biopsy the pathology in the abdomen
e.g. Tuberculous peritonitis
Peritoneal carcinomatosis
Biopsy
Enlarged lymph node
Granulomatous disease (Tuberculosis)
Others
Metastatic carcinoma
HISTOPATHOLOGICAL EVALUATION
Lymph node biopsy showing tumor cells, which have either
vacuolated or pale mucin filled cytoplasm. Many signet ring
cells are seen and occasional mitoses are present. Also seen
are tiny pools of mucin along with the tumor cells. Normal
lymph node tissue is seen at the right upper corner