Pyrexia Of Unknown Origin (PUO)

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Pyrexia Of Unknown Origin (PUO)

  1. 1. Pyrexia of Unknown Origin PUO Prof. Nooruddin Jaffer HCMD Karachi
  2. 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>
  3. 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
  4. 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>
  5. 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
  6. 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>
  7. 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>
  8. 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
  9. 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
  10. 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
  11. 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
  12. 15. Drug-Induced Fever 1- Antibiotic Induced Fever: A. Erythromycin B. Isoniazid C. Penicillin D. Nitrofurantoin E. Procainamide F. Quinidine
  13. 16. 2- Cardiovascular Medication Induced Fever: A. Atropine B. Captopril C. Clofibrate D. Hydralazine E. Hydrochlorothiazide F. Methyldopa G. Nifedipine
  14. 17. 3 - Miscellaneous Medications Inducing Fever: A. Allopurinol B. Antihistamines C. Aspirin D. Cimetidine E. Heparin F. Meperidine G. Phenytoin
  15. 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>
  16. 24. Thank You
  17. 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
  18. 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
  19. 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
  20. 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
  21. 30. PG E2 Cyclic AMP Elevated Thermoregulator Set Point Heat Conservation Heat Production Fever

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