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.
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
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.
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 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.
Fever and Hyperthermia and Pyrexia of unknown origin by Dr Mohammad Hussien for Medical Student .
Ass.Lecturer of Hepatogastroentrology at Kafrelsheikh University.
This document discusses fever and pyrexia of unknown origin (PUO). It begins by defining fever and explaining thermoregulation. Pyrogens that cause fever are discussed, including exogenous and endogenous pyrogens like cytokines. PUO is defined as an unexplained fever persisting over 3 weeks despite testing. Common causes of PUO are discussed, including infections, cancers, and collagen vascular diseases. The approach to evaluating a patient with PUO in stages is also summarized.
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
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.
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 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.
Fever and Hyperthermia and Pyrexia of unknown origin by Dr Mohammad Hussien for Medical Student .
Ass.Lecturer of Hepatogastroentrology at Kafrelsheikh University.
This document discusses fever and pyrexia of unknown origin (PUO). It begins by defining fever and explaining thermoregulation. Pyrogens that cause fever are discussed, including exogenous and endogenous pyrogens like cytokines. PUO is defined as an unexplained fever persisting over 3 weeks despite testing. Common causes of PUO are discussed, including infections, cancers, and collagen vascular diseases. The approach to evaluating a patient with PUO in stages is also summarized.
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 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.
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.
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.
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
This document discusses fever of unknown origin (FUO). It defines FUO and differentiates it from hyperthermia. It describes the four main classifications of FUO: classic, nosocomial, neutropenic, and HIV-associated. For each classification, it outlines the key features, likely causes, diagnostic approach, and treatment considerations. Common causes of FUO include infections, malignancies, and inflammatory diseases. The diagnostic process involves physical exams, imaging, and testing to identify the underlying cause when the fever's origin is not initially apparent.
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.
This document discusses fever of unknown origin (FUO) in children. It begins by explaining how the body regulates temperature and what causes fevers. FUO is defined as a fever over 38.3°C for at least 8 days without diagnosis. Common causes are listed which are often infectious diseases, connective tissue diseases, and neoplasms. Specific infectious etiologies like brucellosis, cat scratch disease, and tuberculosis are explained. The diagnostic approach and evaluations for FUO are outlined including history, physical exam, initial labs, additional testing, and imaging. Empiric treatment is generally not recommended to avoid delaying diagnosis. Herbal treatments used in unconventional medicine for FUO and tuberculosis are also mentioned
The document provides details on evaluating a patient presenting with fever. It includes sections on taking a thorough history with perspectives on biomedical factors, the patient's experience, and contextual background. A review of systems explores all major organ systems for localizing symptoms. The physical exam findings note vital signs and examination of different body systems. Analyzing symptoms like fever patterns, associated issues, and past medical history are essential for determining the underlying cause.
This document discusses the approach to pyrexia of unknown origin (FUO) in children. It defines FUO and classifies it into four categories: classic FUO, healthcare-associated FUO, immune deficient FUO, and HIV-related FUO. For each category, it provides the definition, leading causes, aspects of history and examination to focus on, appropriate investigations, management considerations, and typical time course. It also discusses the various etiologies that can cause FUO and provides guidance on taking a thorough history, performing a physical examination, and selecting initial investigations. The key takeaway is that FUO may represent an uncommon manifestation of a common disease and the workup should be tailored thoughtfully to each case.
Yersinia pseudotuberculosis is a gram-negative bacterium that can cause pseudotuberculosis in humans. It is commonly transmitted through contaminated food and water. Symptoms include abdominal pain, fever, and diarrhea. Left untreated, it can spread from the intestines to other organs. Diagnosis involves culture of stool or blood samples. Treatment involves antibiotics like ciprofloxacin or ceftriaxone for 1-2 weeks.
This document provides a tutorial on fever of unknown origin. It discusses normal body temperature regulation and the definition of fever. It describes the pathogenesis and causes of fever, which can be infectious such as bacterial, viral, parasitic, or non-infectious such as neoplasms, connective tissue disorders, and hypersensitivity diseases. It outlines various patterns of fever and provides classifications. It focuses on fever without a focus, distinguishing fever without localizing signs from fever of unknown origin. It provides guidelines for evaluating and managing febrile infants of different ages from neonates to 3 months.
This document provides information on fever (pyrexia), including:
1. Thermoregulation and how the body maintains a normal temperature of 37°C through the hypothalamus despite environmental variations.
2. Features of a normal body temperature and what constitutes a fever. Fever enhances the immune system and inhibits some microbes.
3. Patterns of fever onset, main phases, and end. Fever's diagnostic features and the importance of taking a thorough medical history are also outlined.
- Dengue fever is a mosquito-borne viral infection caused by any of four dengue virus serotypes. It is a major public health problem in tropical and subtropical parts of the world.
- The disease ranges from a mild fever to potentially lethal dengue hemorrhagic fever. It is transmitted by the bites of infected Aedes mosquitoes, most commonly Aedes aegypti.
- There is no vaccine or antiviral medication available, so treatment is supportive and focused on relieving symptoms. Prevention relies on reducing mosquito habitats and biting exposure through vector control measures.
This document discusses the approach to fever of unknown origin (FUO). It defines FUO as a fever over 101°F for at least 3 weeks without a confirmed diagnosis after initial tests. The differential diagnosis is extensive and includes infections, cancers, and non-infectious inflammatory diseases. The diagnostic approach focuses on finding potentially diagnostic clues by thorough history, exam, initial tests, and more specialized tests like PET scans and biopsies if needed. Treatment depends on the suspected cause but generally avoids antibiotics until a source is found to avoid obscuring the diagnosis. Prognosis has improved over time but malignancies remain a significant cause of mortality in FUO cases.
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 provides information on Dengue fever, including:
- It is caused by Dengue viruses 1-4 and transmitted by Aedes mosquitoes. Infection provides lifetime immunity to one serotype but not others.
- Symptoms range from mild fever to severe dengue hemorrhagic fever/dengue shock syndrome. Secondary infections carry higher risk of severe disease.
- Diagnosis involves physical exam, laboratory tests like platelet count and serology. There is no vaccine or antiviral treatment, only supportive care like fluids and fever control. Prevention focuses on mosquito control and avoidance of bites.
Viral Haemorrhagic Fevers with special reference to DengueSayantan Banerjee
Viral Hemorrhagic Fevers (VHFs) are a group of illnesses caused by distinct families of viruses that cause a severe multisystem syndrome affecting multiple organ systems. They damage the vascular system and impair the body's ability to regulate itself, with many causing severe life-threatening disease. The prototypical VHF is Yellow Fever, but Hemorrhagic Fever with Renal Syndrome caused by Hantaan, Seoul, Dobrava, and Puumala viruses are also considered VHFs. The viruses are RNA viruses enveloped in a lipid coating and depend on an animal or insect host.
Viral haemorrhagic fevers (vhf) plus questions.Shaikhani.
Viral haemorrhagic fevers are caused by several viruses and occur mostly in rural parts of Africa. Lassa fever is widespread in West Africa with an overall mortality of around 15% for hospitalized cases. Ebola outbreaks occur about once per year in countries like Congo, Uganda, and Sudan. While most have mild symptoms, all can present with fever, body aches, and bleeding. Transmission is through contact with infected individuals, animals, or insect bites. Treatment involves isolation and supportive care, with ribavirin used for Lassa fever and South American haemorrhagic fevers.
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 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.
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.
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.
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
This document discusses fever of unknown origin (FUO). It defines FUO and differentiates it from hyperthermia. It describes the four main classifications of FUO: classic, nosocomial, neutropenic, and HIV-associated. For each classification, it outlines the key features, likely causes, diagnostic approach, and treatment considerations. Common causes of FUO include infections, malignancies, and inflammatory diseases. The diagnostic process involves physical exams, imaging, and testing to identify the underlying cause when the fever's origin is not initially apparent.
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.
This document discusses fever of unknown origin (FUO) in children. It begins by explaining how the body regulates temperature and what causes fevers. FUO is defined as a fever over 38.3°C for at least 8 days without diagnosis. Common causes are listed which are often infectious diseases, connective tissue diseases, and neoplasms. Specific infectious etiologies like brucellosis, cat scratch disease, and tuberculosis are explained. The diagnostic approach and evaluations for FUO are outlined including history, physical exam, initial labs, additional testing, and imaging. Empiric treatment is generally not recommended to avoid delaying diagnosis. Herbal treatments used in unconventional medicine for FUO and tuberculosis are also mentioned
The document provides details on evaluating a patient presenting with fever. It includes sections on taking a thorough history with perspectives on biomedical factors, the patient's experience, and contextual background. A review of systems explores all major organ systems for localizing symptoms. The physical exam findings note vital signs and examination of different body systems. Analyzing symptoms like fever patterns, associated issues, and past medical history are essential for determining the underlying cause.
This document discusses the approach to pyrexia of unknown origin (FUO) in children. It defines FUO and classifies it into four categories: classic FUO, healthcare-associated FUO, immune deficient FUO, and HIV-related FUO. For each category, it provides the definition, leading causes, aspects of history and examination to focus on, appropriate investigations, management considerations, and typical time course. It also discusses the various etiologies that can cause FUO and provides guidance on taking a thorough history, performing a physical examination, and selecting initial investigations. The key takeaway is that FUO may represent an uncommon manifestation of a common disease and the workup should be tailored thoughtfully to each case.
Yersinia pseudotuberculosis is a gram-negative bacterium that can cause pseudotuberculosis in humans. It is commonly transmitted through contaminated food and water. Symptoms include abdominal pain, fever, and diarrhea. Left untreated, it can spread from the intestines to other organs. Diagnosis involves culture of stool or blood samples. Treatment involves antibiotics like ciprofloxacin or ceftriaxone for 1-2 weeks.
This document provides a tutorial on fever of unknown origin. It discusses normal body temperature regulation and the definition of fever. It describes the pathogenesis and causes of fever, which can be infectious such as bacterial, viral, parasitic, or non-infectious such as neoplasms, connective tissue disorders, and hypersensitivity diseases. It outlines various patterns of fever and provides classifications. It focuses on fever without a focus, distinguishing fever without localizing signs from fever of unknown origin. It provides guidelines for evaluating and managing febrile infants of different ages from neonates to 3 months.
This document provides information on fever (pyrexia), including:
1. Thermoregulation and how the body maintains a normal temperature of 37°C through the hypothalamus despite environmental variations.
2. Features of a normal body temperature and what constitutes a fever. Fever enhances the immune system and inhibits some microbes.
3. Patterns of fever onset, main phases, and end. Fever's diagnostic features and the importance of taking a thorough medical history are also outlined.
- Dengue fever is a mosquito-borne viral infection caused by any of four dengue virus serotypes. It is a major public health problem in tropical and subtropical parts of the world.
- The disease ranges from a mild fever to potentially lethal dengue hemorrhagic fever. It is transmitted by the bites of infected Aedes mosquitoes, most commonly Aedes aegypti.
- There is no vaccine or antiviral medication available, so treatment is supportive and focused on relieving symptoms. Prevention relies on reducing mosquito habitats and biting exposure through vector control measures.
This document discusses the approach to fever of unknown origin (FUO). It defines FUO as a fever over 101°F for at least 3 weeks without a confirmed diagnosis after initial tests. The differential diagnosis is extensive and includes infections, cancers, and non-infectious inflammatory diseases. The diagnostic approach focuses on finding potentially diagnostic clues by thorough history, exam, initial tests, and more specialized tests like PET scans and biopsies if needed. Treatment depends on the suspected cause but generally avoids antibiotics until a source is found to avoid obscuring the diagnosis. Prognosis has improved over time but malignancies remain a significant cause of mortality in FUO cases.
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 provides information on Dengue fever, including:
- It is caused by Dengue viruses 1-4 and transmitted by Aedes mosquitoes. Infection provides lifetime immunity to one serotype but not others.
- Symptoms range from mild fever to severe dengue hemorrhagic fever/dengue shock syndrome. Secondary infections carry higher risk of severe disease.
- Diagnosis involves physical exam, laboratory tests like platelet count and serology. There is no vaccine or antiviral treatment, only supportive care like fluids and fever control. Prevention focuses on mosquito control and avoidance of bites.
Viral Haemorrhagic Fevers with special reference to DengueSayantan Banerjee
Viral Hemorrhagic Fevers (VHFs) are a group of illnesses caused by distinct families of viruses that cause a severe multisystem syndrome affecting multiple organ systems. They damage the vascular system and impair the body's ability to regulate itself, with many causing severe life-threatening disease. The prototypical VHF is Yellow Fever, but Hemorrhagic Fever with Renal Syndrome caused by Hantaan, Seoul, Dobrava, and Puumala viruses are also considered VHFs. The viruses are RNA viruses enveloped in a lipid coating and depend on an animal or insect host.
Viral haemorrhagic fevers (vhf) plus questions.Shaikhani.
Viral haemorrhagic fevers are caused by several viruses and occur mostly in rural parts of Africa. Lassa fever is widespread in West Africa with an overall mortality of around 15% for hospitalized cases. Ebola outbreaks occur about once per year in countries like Congo, Uganda, and Sudan. While most have mild symptoms, all can present with fever, body aches, and bleeding. Transmission is through contact with infected individuals, animals, or insect bites. Treatment involves isolation and supportive care, with ribavirin used for Lassa fever and South American haemorrhagic fevers.
The document summarizes information about Ebola virus hemorrhagic fever and Lassa virus hemorrhagic fever. It describes the etiology, epidemiology, signs and symptoms, diagnosis, treatment and prevention of the two viral hemorrhagic fevers. Ebola virus causes a severe multisystem disease in humans characterized by fever, headache and bleeding. Lassa fever is endemic in West Africa and transmitted from rodents to humans, causing fever, bleeding and organ dysfunction. Treatment involves supportive care and the antiviral drug ribavirin.
The lecture gives concise review about the main four groups of viruses causing hemorrhagic fever i.e. Flavivirues, Filoviruses, Arenaviruses and Bunyaviruses.
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.
FEVER of UNKNOWN ORIGIN(FUO) is defined as a temperature greater than 38°C (101°F) for more than 3 weeks with a failure to determine a diagnosis after a week of inpatient investigation. The most common causes are infections (30-50%), neoplastic diseases (5-30%), and collagen vascular diseases (10-20%). The diagnostic approach involves thorough physical exams, laboratory tests including blood counts and inflammation markers, and radiological exams. Treatment focuses on identifying the underlying cause through diagnostic tests rather than empirical antibiotics. Children with FUO generally have a better prognosis than adults and the fever often resolves spontaneously even if the cause is not determined.
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.
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.
19. presenting problems in infectious diseasesAhmad Hamadi
This document discusses the evaluation and management of fever. It notes that the differential diagnosis for fever is broad and initial screening investigations should include blood tests, imaging, and cultures of potential sites of infection depending on symptoms. For patients where the cause is not obvious, further targeted investigations are needed. The document also discusses considerations for evaluating fever in people who inject drugs, including risks related to injection practices and common infections in this population.
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
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 provides an outline for a presentation on the pathophysiology and management of febrile neutropenia. It begins with definitions of febrile neutropenia and discusses the epidemiology, including common underlying malignancies. The pathophysiology of fever and neutropenia is explained. Clinical features, differential diagnosis, and guidelines for risk stratification and treatment approaches including monotherapy versus duotherapy are summarized. Treatment is tailored based on risk factors and includes broad-spectrum intravenous antibiotics with options for transitioning to oral antibiotics in low risk patients.
1. A 62-year-old woman with end stage renal disease on hemodialysis presents with weakness, fever, and chills. She has risk factors for infective endocarditis including diabetes and receiving dialysis.
2. Infective endocarditis is a serious infection of the heart valves. It requires alterations in the heart valves along with bacteremia for infection to develop. Common causes are viridans streptococci, staphylococci, and enterococci.
3. Initial empirical treatment should cover common gram-positive organisms given her risk factors, such as penicillin plus gentamicin for streptococci or vancomycin plus gentamicin for staphy
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.
Abir, an 8-year-old boy, was admitted to the hospital with difficulty swallowing, talking, and weakness in his upper and lower limbs. He had a fever 20 days prior. Acute flaccid paralysis (AFP) is characterized by rapid onset weakness that can include respiratory and bulbar weakness. Differential diagnoses for AFP include Guillain-Barré syndrome, transverse myelitis, poliomyelitis, traumatic neuritis, and hypokalemic paralysis. Proper management of AFP requires assessing respiratory function, bulbar weakness, cardiovascular stability, and ruling out electrolyte imbalances or spinal cord compression.
Tuberculosis is caused by the bacterium Mycobacterium tuberculosis and usually affects the lungs. It remains a major global health problem, with around 10 million new cases and 1.5 million deaths per year worldwide according to the WHO. Tuberculosis flourishes in conditions of poverty, crowding and immunosuppression. Clinical manifestations vary depending on whether the infection is primary or secondary, and can include cough, fever, weight loss, or disseminated disease. Diagnosis involves smear, culture and radiography. Standard treatment is 6 months of multiple antitubercular drugs. Effectiveness of treatment is assessed by repeat smears and cultures after 2 and 5 months.
This document outlines the case study of a 39-year-old man presenting with fever and right lumbar pain. It discusses typhoid fever including its definition, epidemiology, risk factors, transmission, pathophysiology, signs and symptoms, diagnostic methods, treatment, complications, differential diagnoses, and prevention. The patient was diagnosed with typhoid fever based on a positive typhoid-specific test and treated with antibiotics and rehydration.
This document summarizes several viral diseases that affect ruminants, including bovine ephemeral fever, bovine respiratory syncytial virus, parainfluenza-3, bovine viral diarrhea, infectious bovine rhinotracheitis, and others. For each disease, it describes the etiology, epidemiology, clinical signs, pathogenesis, diagnosis, treatment and prevention. The document provides detailed information on the causative agents, transmission, impact on cattle, prevalence studies in Thailand and other countries, and control methods for bovine viral diarrhea, an economically important viral disease.
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 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.
The hypothalamus controls body temperature through neurons that receive signals from temperature receptors in the skin and blood. These signals are integrated in the hypothalamus' temperature regulation center to maintain a normal temperature of around 37°C. Fever is defined as a temperature greater than 37.2°C in the morning or 37.7°C in the afternoon. Common causes of fever in the ICU include infections like ventilator-associated pneumonia as well as non-infectious causes like drug reactions. Blood cultures, sputum cultures, urine cultures and imaging tests may help diagnose the cause, and treatment is aimed at the underlying condition.
Fever of unknown origin (FUO) presents a diagnostic challenge for pediatricians. It is defined as a fever over 38°C for at least 8 days without an identified cause. Common causes include infections, autoimmune or inflammatory conditions, and cancers. A thorough history, physical exam, and testing are required to identify the source. Distinguishing FUO from self-limited fever episodes is important to avoid unnecessary testing. Ongoing evaluation is also needed, as some cases remain undiagnosed.
This document discusses several infectious diseases, including meningitis, encephalitis, poliomyelitis, mumps, tetanus neonatorum, and pertussis. It describes the etiology, clinical manifestations, diagnosis, and treatment of each disease. Meningitis can be caused by bacteria, viruses, or fungi and symptoms include fever, headache, and neck stiffness. Encephalitis is usually caused by viruses and may cause seizures, behavioral changes, and neurological deficits. Poliomyelitis is caused by polioviruses and can cause flu-like symptoms or potentially paralysis.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
1. Approach to a patient with
fever of unknown origin
Dr. Adrija Hajra; 2nd year MD student; Internal Medicine; SSKM & IPGMER
2. Fever is a protective response to infection and injury. An elevated temperature
enhances the body’s innate defense mechanisms by making conditions less favorable
for infectious microorganisms to thrive.
Elevated body temperature decreases the levels of iron in the bloodstream,
thus inhibiting the growth of some microorganisms.
There are some microorganisms that are heat sensitive, and do not grow well at
elevated body temperature.
3. What is PUO
Originally defined in 1961 by Petersdorf and Beeson
Fever >38.3C on two occasions
Fever for more then three weeks
Uncertain diagnosis after one week in hospital
4. Fever of Unknown Origin - Definition
1. Fever >38.3 degree C ( 101 degree F) on at least two occasions
2. Illness duration of > or = 3 weeks
3. No known immunocompromised state
4. Diagnosis that remains uncertain after a thorough history-taking, physical examination, and
the following obligatory investigations: determination of erythrocyte sedimentation rate (ESR)
and C-reactive protein (CRP) level; platelet count; leukocyte count and differential;
measurement of levels of hemoglobin, electrolytes, creatinine, total protein, alkaline
phosphatase, alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase,
creatine kinase, ferritin, antinuclear antibodies, and rheumatoid factor; protein electrophoresis;
urinalysis; blood cultures (n = 3); urine culture; chest x-ray; abdominal ultrasonography; and
tuberculin skin test (TST) .
5. The answer will be A
The commonest cause of PUO is:
a) A common disease presenting in an atypical way.
b) A rare disease presenting in atypical way.
c) A common disease presenting typically.
d) A rare disease presenting typically.
6. Infection accounts for about 20-25 % of cases of FUO in Western
countries; next in frequency are neoplasms and non infectious
inflammatory diseases.
Outside Western countries infection causes 43% cases
of FUO.
Up to 50% of these cases are due to Tuberculosis.
EPIDEMIOLOGY:
8. A study on FUO patients in SKIMS, Srinagar(July 2010- Sept
2012):
n=91
Infection=40 cases, (32.26% Brucellosis)
Malignancy=11 cases
Inflammatory disease=11 cases
Miscellaneous=4 cases
Undiagnosed=25 cases
Mir T, Dhobi GN, Koul AN, Saleh T. Clinical profile of classical FUO. Caspian J Intern Med 2014; 5(1): 35-39.
Studies in India:
9. Although in India, approximately 80% of the population has close contact with domestic or wild
animals owing to their residence or occupation, carrying a risk for zoonotic diseases including
brucellosis, but only less than 10% of cases of FUO are attributed to brucellosis as evident from
various studies from India. This could be explained by either the disease is overlooked or
difficulty in correct diagnosis.
Kejariwal D et al from India observed his series of 100 cases of FUO, 53% were attributed to
tuberculosis, predominantly extra pulmonary. Sharma et al. reported 50% cases of FUO caused
by tuberculosis in northern India.
Kejariwal et al. and Ramamoorthy et al. estimated an incidence of 17% and 3.61% of
malignancy as a case of FUO, respectively.
Ramamoorthy K and Bang M. Pyrexia of unknown origin. CME 2004; pp; 385-390. Availible at: URL: http://appiindia.org/pdf/pg-med-2004/chapter-52. Accessed Nov 18,
2013. Pdf.
Kejariwal D, Sarkar N, Chakraborti SK, Agarwal V, Roy S. Pyrexia of Unknown Origin: A Prospective Study of 100 Cases. J Postgrad Med 2001; 47: 104-7.
Sharma BK, Kumari S, Varma SC, Sagar S, Singh S. Prolonged undiagnosed fever in North India. Trop Geogr Med 1992; 44: 32-6.
10. Four Proposed Categories of FUO
Based on potential etiology of FUO
All require temperature > 38.3C
Categorization be especially helpful in organizing an “approach” to
patient evaluation
Classic
Nosocomial
Immune-deficient (neutropenic)
HIV-related
11. Classic Category of FUO
Definition:
Duration > 3 weeks, evaluation of at least 3 outpatient visits or 3 days in-
hospital
Common etiologies:
Infection, malignancy, CVD
12. Nosocomial Category of FUO
Definition:
Hospitalization of at least 24 hrs with no fever on admission,
evaluation of at least 3 days
13. Common causes
This is commonly related to hospital associated factors such as,
Surgery
use of urinary catheter
intravascular devices (i.e. "drip", pulmonary artery catheter)
drugs (antibiotics induced Clostridium difficile colitis, and drug fever)
immobilization (decubitus ulcers). Sinusitis in the intensive care unit is
associated with nasogastric and orotracheal tubes.
deep-vein thrombophlebitis
pulmonary embolism,
transfusion reactions, acalculous cholecystitis
alcohol/drug withdrawal
adrenal insufficiency
pancreatitis
14. IMMUNE DEFICIENT PUO
Fever >38.0° C, >3 days duration, negative cultures after 48 hrs.
Higher chance of atypical infections.
Immunodeficiency can be seen in patients receiving chemotherapy
or in hematologic malignancies.
Fever is concommittent with neutropenia (neutrophil <500/uL) or
impaired cell-mediated immunity. The lack of immune response
masks a potentially dangerous course.
Infection is the most common cause
15. HIV-Associated Category of FUO
Definition:
Duration of at least 4 weeks for outpatients and 3 days for
inpatients, HIV confirmed
Etiologies:
Cytomegalovirus, MAC, Pneumocystis, drugs, Kaposi’s,
lymphoma
20. Etiologies of FUO
Infection
Tuberculosis: .. Disseminated
The single most common infection in most PUO series
except in children and elderly.
Usually extrapulmonary or miliary
Pulmonary TB in AIDS is often subtle (normal chest x-
rays → 15 – 30%).
PPD is (+ve) < 50% of TB with PUO.
Diagnosis often requires Bx of LN/Liver/Bone marrow.
Sputum smear (+) only 25%
21. Etiologies of FUO
Abscess:
Usually located in abdomen or pelvis.
Secondary to appendicitis or diverticulitis.
Amoebic liver abscess is one of the common causes
Pyogenic liver abscess usually follow biliary tract
dis./abd. Suppuration.
Splenic abscess is usually secondary to
hematogenous seeding.
Perinephric or renal abscess is usually secondary to
UTI.
22. Etiologies of FUO
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
Brucella } Special media
Legionelle } long time
Mycoplasm/Chlamydia }
Fungal → usually sterile
Peripheral signs may not be detected.
Right-side Endocarditis → Lack murmurs → self antibiotics →
growth (-ve).
23. Etiologies of FUO
Lymphoma:
Fever is a well-recognized manifestation.
Source of fever → production of cytokines.
Fever is a negative prognostic factor …
Renal Cell Carcinoma (Adult)
20% → Fever
Microscopic hematuria/Erythromytosis
24. Etiologies of FUO
Wilms Tumor (Children)
Peak incidence 2-3 years.
Abdominal mass but FEVER can be a presentation.
Solid Tumor
Fever is rare except:
Secondaries to the liver
Ductal obstruction or perforation … like
cholangioacarcinoma or ampulla ca.
Lung carcinoma with obstruction and pneumonia.
25. Etiologies of FUO
Still’s Disease Adult Onset
Age 16 – 33 yrs with (-ve) RF & ANA
Fever is high and spiking with Temp. up to 41.6oC
Fever is either intermittent or remittent … peaks typically
at night
Most patient seek medical attention within 2 weeks.
A distinctive evanescent macular or maculopapular rash is
typically present during the course of the illness.
26. Etiologies of FUO
Diagnosis is strictly a clinical one … RF is almost
uniformally negative.
Other features → myalgias, arthritis may appear after
weeks or months & leukocytosis (neutrophils),
hepatosplenomegaly & lymphadenopathy.
Very high serum ferritin … more than 2000
27. Etiologies of FUO
Temporal Arteritis:
Very serious condition if not diagnosed early
… Very difficult to establish the etiology of fever if one
does not have the index of suspicion
Typically Caucasian but it occurs in others
Fever and malaise may be the only manifestation.
Headache is the most common.
Raised ESR is suggestive
28. Etiologies of FUO
Polymyalgia Rheumatica:
Can cause fever, arthralgia, myalgia & ↑ ESR > 50.
Chronic muscle complaints → symmetrical pain and
stiffness that are typically worse at morning and affects
lumbar spine and large proximal muscles.
Other vasculitides that cause FUO:
Polyarteritis nodosa
Wegener’s Granulomatosis
Mixed Cryoglobulinemia
29. Drug Fever
Almost any drug can cause fever
PATHOGENESIS
Contamination of the drug with a pyrogen or microorganism.
Related to the pharmacologic action of the drug itself (e.g
amphotericin B).
Allergic (hypersensitivity) reaction to the drug.
30. Fever out of proportion to clinical picture
Pattern of fever variable
Associated findings:Rigor (43%), Myalgia (25%), Rash (18%),
Headache (18%)
Leukocytosis (22%), Eosinophilia (22%), Serum sickness (fever,
swelling, rash, LN enlargement), Proteinuria, Abnormal liver
function test
32. Onset and duration:
Onset: Typically occur 7 to 10 days (can be up to 21 days) after
initiation
Usually resolves within 48 hrs after discontinuation of the drug
(depending on the half-life of the drug)
35. History
Fever (Pattern, periodicity, how was it measured
associated symptoms such as sweating, vomiting, headaches etc.)
Past medical and surgical history ( prosthesis in situ, cardiac illness, diabetes,
h/o transplant)
Occupation, Travel
Pets
Contact with ticks, animals
Diet (Drinking unpasteurised milk)
History of addiction
Sexual behaviour(any other high risk behaviour)
Drug history
Immunisation
36. Diagnostic Approach –
Physical Examination
The general appearance
The skin: rash, cutaneous findings of endocarditis
Perineum and feet
Spine,bones,joints,abdomen,thyroid
Digital rectal and pelvic examination
Lymphadenopathy
Cardiac examination
Repeated examination may be needed
40. Points to be rememberedduring evaluation of a patient with FUO :
Previous case reports and history given by the patient should be
reviewed properly.
Initial errors of omission may cause unnecessary investigations.
Even when initial evaluation was thorough, patients often remember
new details when questioning is repeated.
Conversely clinicians should not ignore previous test results and
should not repeat tests without considering how likely results are
to be different.
44. Abdominal CT
Useful to look for abdominal lymphoma and abscess
Diagnostic yield in case series 19%
Clinical follow-up showed that only 1/32 patients with normal scans had an intra-abdominal cause
for FUO
Chest CT
Invaluable in identification of
small nodules, hilar or
mediastinal adenopathy.
45. Liver Biopsy:
Diagnostic yield 14%-17% regardless of whether abnormal physical exam or
liver enzymes exist
Complications in FUO from biopsy only 0.32% at most
Recommended
Temporal artery biopsy:
Large studies comprised of elderly with FUO lacking
Arteritis cause of FUO ~16% of patients
Safe, recommended in elderly with FUO
46. Other tissue diagnosis: Bone marrow, skin, pleura, lymph nodes,
intestine.
(biopsy specimens should be evaluated by histopathologic
examination & cultured for bacteria, fungi, viruses, mycobacteria or
sent for PCR)
Splenic aspiration: visceral leishmaniasis
Bone marrow biopsy has a diagnostic yield up to 15%, most often
revealing hematologic malignancy, myelodysplasia, or tuberculosis, and
also identifying brucellosis, typhoid fever or visceral leishmaniasis.
Muscle biopsy and skin biopsy from rashes may confirm vasculitis.
Laparoscopy & abdominal exploration
48. Recent studies have highlighted the usefulness of early use of FDG-PET
([18F] fluoro-2-deoxy-D-glucose positron emission tomography), which
may be useful in helping to pinpoint a source of fever.
Fluoro-2-deoxy-D-glucose is preferentially taken up by cells such as
tumor and inflammatory cells, in which glucose metabolism is high.
The diagnostic yield may be increased further by simultaneously using
FDG-PET with conventional computed tomography (CT). Several small
retrospective studies have shown sensitivities from 56% to100%,
specificities from 75% to 81%, and negative predictive values of 100%,
when a combination of CT and FDG-PET scanning is used.
Role of FDG-PET:
49. A high NPV has previously been reported for
FDG-PET/CT in the diagnosis of large vessel
vasculitis, with a sensitivity ranging between 77%
and 92% and specificity ranging between 89%
and 100%. 18F-FDG-PET/CT offers a useful
contribution to the diagnostic work-up of large
vessel vasculitis.
http://dx.doi.org/10.1016/j.ijid.2013.10.009
50. Nuclear scintigraphy, for example with 67Ga-citrate and111In labelled
leukocytes, is a much cheaper and more widely available imaging
technique that may perform a similar role in localizing pathology, though it
is more time consuming and less sensitive and specific than FDG-PET.
However, the probability of reaching a diagnosis was observed in 71% with
a sensitivity of 75% and specificity 83%. Leukocyte scintigraphy may be
helpful in diagnosing inflammatory and infectious conditions and rarely of
use in neoplasm.
Nuclear study:
51. History is crucial. Will help to narrow down
possible list of diseases.
Exposure: Duration, exact location, urban/rural,
type of accommodation
Timing: Consider incubation period and onset
of symptoms. 66% of dengue presents within
one week of return. 34% of hepA presents
within 6 weeks
Food history is important
Sexual history is important
Vaccine history
FOR TRAVELLERS
52. Evaluation
Thick and Thin smears for malaria
Blood count
Renal profile
Liver profile: hepatitis
Coagulation screen
CXR if respiratory symptoms
53.
54.
55. Treatment:55
Limitation and risk of empirical therapeutic trials:
Rarely specific
Underlying disease may remit spontaneously false impression of
success.
Disease may respond partially and this may lead to delay in specific
diagnosis.
Side effect of the drugs can be misleading.
In general, empirical therapy has little or no role in cases of fever of unknown origin
(FUO).
Treatment should be directed toward the underlying cause, as needed,
once a diagnosis is made.
56. Empirical therapeutic trials with antibiotics, glucocorticoids, or
antituberculous agents should be avoided in FUO except when a
patient's condition is rapidly deteriorating after the aforementioned
diagnostic tests have failed to provide a definite diagnosis.
Empirical antibiotic therapy: Hemodynamic instability or neutropenia Good indication
Anti tuberculous therapy: If the skin test is positive
Granulomatous disease with anergy
Miliary tuberculosis
If the fever does not respond after 6 weeks Another diagnosis
57. Colchicine is highly effective in preventing attacks of familial Mediterranean fever.
With colchicine treatment most patients show remarkable improvements in the
frequency and severity of subsequent febrile episodes within weeks to months.
The response of adult onset Still’s disease to NSAIDS is dramatic in some cases.
The effects of glucocorticoids on giant cell arteritis and polymyalgia rheumatica
are equally impressive.
The ability of glucocorticoids to mask symptoms while permitting the spread
of infection dictates that their use should be avoided unless infectious diseases
have been ruled out and inflammatory disease is probable and is likely to be
debilitating or threatening.
58. Anakinra:
Interleukin (IL)1 is a key cytokine in local and systemic inflammation
and the febrile response.
The availability of specific IL-1-targeting agents has revealed a pathologic role of
IL-1 mediated inflammation in a growing list of diseases.
Anakinra, a recombinant form of the naturally occurring I L-1 receptor
antagonist ( lL-1Ra), blocks the activity of both IL-1α and IL-1ß.
Anakinra is extremely effective in the treatment of many autoinflammatory
syndromes, such as
familial Mediterranean fever,
cryopyrin-associated periodic syndrome,
tumor necrosis factor receptor-associated periodic syndrome,
hyper- lgD syndrome.
59. PROGNOSIS:
FUO-related mortality rates have continuously declined over
recent decades.
The majority of fevers are caused by treatable diseases.
Studies have also shown that malignancy accounts for
most FUO-related deaths.
Non Hodgkin's lymphoma carries a disproportionately high
death toll.
In nonmalignant FUO, fatality rates are very low.
The good outcome in patients without a diagnosis confirms
that potentially lethal occult diseases are very unusual.
Empirical therapy with antibiotics, antituberculous agents, or
glucocorticoids is rarely required in stable patients.
In less affluent regions, infectious diseases are still a major
problem.
60. CONCLUSION:
FUO is often a diagnostic dilemma.
Infections comprise ~30% of cases.
Diagnostic approach should occur in a step-wise fashion
Patients that remain undiagnosed generally have a good
prognosis.
18F-FDG-PET/CT has an incremental diagnostic value in the
diagnosis and management of FUO. In the future, 18F-FDG-
PET/CT may well be included in the initial diagnostic work-up for
the investigation of the etiology of FUO.