Dr. Honey Savla presents information on pyrexia of unknown origin (PUO). PUO is defined as a fever over 38.3°C for at least 3 weeks without a confirmed diagnosis after initial investigations. An approach to a PUO patient involves 4 stages - thorough history and screening tests in stage 1, followed by focused tests and imaging in stage 2, invasive procedures in stage 3 if needed, and therapeutic trials in stage 4. Prognosis is generally better the longer a diagnosis remains elusive, but delay affects outcomes for certain conditions like tuberculosis if not identified promptly.
fever of unknown origin is defined as
1) Fever >38.3*C (101*F) on atleast 2 occasions
2) illness duration more than 3 weeks
3) No known immunocompromised state
4) Uncertain diagnosis despite one week of inpatient evaluation
Fever and Hyperthermia and Pyrexia of unknown origin by Dr Mohammad Hussien for Medical Student .
Ass.Lecturer of Hepatogastroentrology at Kafrelsheikh University.
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.
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
Pyrexia of unknown origin (PUO) may be defined as any febrile illness (temperature greater than 38°C) lasting 3 weeks or longer, without any obvious cause and failure to reach a diagnosis despite one week of inpatient investigation.
In these conditions there is thus a special need for a lab diagnosis
to guide the choice of
appropriate therapy.
Fever ≥ 38.3°C (>101°F) on several occasions
fever of unknown origin is defined as
1) Fever >38.3*C (101*F) on atleast 2 occasions
2) illness duration more than 3 weeks
3) No known immunocompromised state
4) Uncertain diagnosis despite one week of inpatient evaluation
Fever and Hyperthermia and Pyrexia of unknown origin by Dr Mohammad Hussien for Medical Student .
Ass.Lecturer of Hepatogastroentrology at Kafrelsheikh University.
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.
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
Pyrexia of unknown origin (PUO) may be defined as any febrile illness (temperature greater than 38°C) lasting 3 weeks or longer, without any obvious cause and failure to reach a diagnosis despite one week of inpatient investigation.
In these conditions there is thus a special need for a lab diagnosis
to guide the choice of
appropriate therapy.
Fever ≥ 38.3°C (>101°F) on several occasions
The syndrome of pyrexia of unknown origin (PUO) was first defined in 1961 but remains a clinical challenge for many physicians. Different subgroups with PUO have been suggested, each requiring different investigative strategies: classical, nosocomial, neutropenic, and HIV-related. This could be expanded to include the elderly as a fifth group. The causes are broadly divided into four groups: infective, inflammatory, neoplastic, and miscellaneous. Increasing early use of positron emission tomography–computed tomography (PET-CT) and the development of new molecular and serological tests for infection have improved diagnostic capability, but up to 50% of patients still have no cause found despite adequate investigations. Reassuringly, the cohort of undiagnosed patients has a good prognosis. In this article we review the possible aetiologies of
The definition of pyrexia of unknown origin (PUO) dates back to 1961; it was described as a persistent fever above 38.3°C (100°F) that evades diagnosis for at least 3 weeks, including 1 week of investigation in hospital. PUO and present a systematic clinical approach to the investigation and management of patients, recommending potential second-line investigations when the etiology is unclear
Tuberculosis diagnosis and investigations.pptxshreya290503
This ppt includes all the investigations for the diagnosis of pulmonary and extrapulmonary tuberculosis. This will be a great help in your university exams as well as competitive exams. All the best.
2. Pyrexia of Unknown Origin (PUO)
Definition:
by Petersdorf and Beeson in 1961
“Temperature higher than 38.3°C (101°F) on atleast two occasions ,
persisting without diagnosis for at least 3 weeks,
no known immunocompromised state,
Diagnosis that remains uncertain after a thorough history taking physical
examination and obligatory investigations.
11. Stage 2
• Review history & repeat physical examination
• Specific investigations
• Repeat sampling of blood & other body fluids.
• Skin tests
• Blood for antibodies – HIV antibodies, CMV
antibodies, EBV antibodies.
12. • Serological tests for toxoplasmosis, psittacosis and
rickettsial infections, syphillis.
• Serology for rheumatologic disorders like antinuclear
and antineutrophilic cytoplasmic antibodies,
rheumatoid factor
• Quatiferon TB Gold in tube and T spot TB – detects
ϒ interferon release.
13. Microscopy:
• Direct examination of blood smears: malaria,
trypanosomiasis ,babesia, leishmania, relapsing fever
rat bite fever, ehrlichiosis.
• Intra cellular organisms, bacteria, inclusion bodies,
protozoal amastigotes.
14. Imaging studies:
• GI contrast study
• High resolution spiral CT
• Arteriography
• Echocardiography
• Duplex imaging
16. Stage 3
• Biopsy of liver and bone marrow
• Lymph node biopsy
• Blind biopsy of 1 or both temporal artery in
patient > 50 yrs
• Exploratory laparotomy
17. MANAGEMENT
• Therapy withheld until cause is found
• Empirical corticosteroids or anti inflammatories in
temporal arteritis.
• Vital sign instability & neutropenia –
Fluoroquinolones + piperacillin,
vancomycin + ceftazidime/cefepime/
carbapenem with or without aminoglycoside,
18. Management of Nosocomial PUO:
• Change of IV lines, catheters
• Empirical treatment:
Vancomycin for MRSA
Broad spectrum Gram negative coverage
Piperacillin + tazobactum
Ticarcillin + clavulinic acid
Meropenem
19.
20. Stage 4
Therapeutic trials:
• Empirical treatment with corticosteroids or NSAIDS
or antimicrobials
• Antimycobacterial agents in AIDS & neutropenic
• Blind therapy- delay in correct diagnosis
21. PROGNOSIS
• Poorest prognosis - elderly & malignant
• Delay in diagnosis affects prognosis of
intraabdominal infections, miliary tuberculosis,
disseminated fungal infections & recurrent
pulmonary emboli
• Undiagnosed PUO for prolonged duration – good
prognosis.