description of Fever of unknown origin

1. PYREXIA OF UNKNOWN
ORIGIN

2. • Fever of unknown origin (FUO)
Petersdorf and Beeson in 1961
as
temperatures higher than
38.3°C (more than 3 weeks)
Diagnos is not made despite 1
week of in-patient
investigation

3. New classification:
• Durack and Street : new system for
classification of FUO:
• (1) classic FUO,
• (2)Nosocomial FUO,
• (3) Neutropenic FUO, and
• (4) FUO associated with HIV infection

4. (1) classic FUO:
• Temprature of > 38.3oc
• Fever >3 weeks
• Failure to reach diagnosis evenafter three
outpatient visits in the hospital.

5. • 1. Diagnosis ?
• A 50 year old man was admitted with fever
of three weeks duration. On examination
there was hepatosplenomegaly. Routine
urine and blood examinations were normal.
Widal test and Mantouex test were negative.
Chest X-Ray and HIV were negative. Liver
biopsy showed presence of granulomas

6. • (2) Nosocomial FUO:
• Fever > 38.3 C
• Develop in hospital (not menifestated at time
of admission)
• Remain undiagnosed evenafter 3 weeks of
investigation
• Incubation of culture : no source

7. • Diagnosis?
• A 30 year old farmer working in a diary
farm in Tamil Nadu was admitted to the
ward with low grade fever and evening rise
of temperature. On examination there was
generalized lymphadenopathy and hepato
splenomegaly. Blood routine, Chest X-ray
PA view & Blood Widal test were negative

8. • 3) Neutropenic FUO:
• Temprature of > 38.3oc
• Neutrophil count (<500/micro lit)
• 3 days investigation and 2 days culture : no
source

9. • Diagnosis ??
• A 19 year old girl was diagnosed to have
infective endocarditis, because she had
fever, pallor and systolic murmur. Repeated
blood cultures were negative and she did
not improve with antibiotics given for SBE.
After 4 weeks she was still febrile. This time CXR
was diagnostic
Tuberculosis

10. • 4) HIV Associated FUO:
• Temperature of > 38.3oc (>4weeks)
• HIV infection confirmed
• 3 days of investigations and 2 days of culture :
no source

11. • 10. Diagnosis?
• A 15 year old boy was admitted with
history of fever of seven days duration.
Clinical examination showed a generalized
maculopapular rash and generalized
lymphadenopathy, hepatosplenomegaly. All
the routine investigations for a underlying
bacterial infection were found negative

12. Causes of FUO :
1) INFECTIONS (36%)
2) NEOPLASM (19%) : Lymphoma , leukemia
,myeloma , renal ,colon and liver cancer
3) NON INFECTIOUS INFLAMMATORY DISEASE
(19%) : rheumatic arthritis , SLE
4) MISCELLANEOUS CAUSE (19%) :
Granulomatous disease , inherited and
metaboloc disorder

13. LABORATOEY DIAGNOSIS
• 1) SPECIMEN COLLECTION : Following
to clinical history (travel , immunization
, exposure to any other patient) and
physical examination.
• help
blood , bone marrow pus urine

14. • 2) Microscopy :
Blood : Malaria ( ring form and
gametocytes) , Microfilariae ,
Leishmania donovani (LD body or
Amastigote) and trypanosomes
(trypomastigote form)

15.  STOOL: Cysts , ova and trophozoit

16.  gram stain : pus , sputum and others (GNB and
GPC)

17.  ZN STAIN : M.tuberculosis

18.  Blood culture : typhoid fever , brucellosis
Microorganism co2 Hydrogen
INCREASES (H) DECREASE PH
react
3) culture :

19.  L J media : M.tuberculosis

20.  Blood agar : pus ,csf etc

21.  Sabouraud dextrose agar : fungus

22. 4) SEROLOGY :
Cell line culture : virus (CMV)
ELISA and rapid test : HIV , HBV and HCV
STANDARRD AGGLUTINATION TEST : Brucellosis
Microscopic agglutination test : leptospirosis
Cold agglutination test : Mycoplasma
Paul bunnel test: infectious mononucleosis
 Widal test : typhoid fever
 Microimmunofluorescence test or CFT : chlamydial
infections
RA factor : rheumatoid arthritis

23. • 5) Molecular Test : Pcr (amplify specific gene)
• 6) other tests:
 CBC: Neutrophil count ( pyogenic infections)
Raised ESR : may tuberculosis