A. Fever without localizing symptoms, rash or lymphadenopathy
i. Fever less than 3 weeks
Here a distinctive diagnosis is less pressing as the clinical condition is less severe than FUO. Most of the conditions listed below undergo spontaneous resolution. Supportive care and reassurance and follow up 3 weeks later are recommended.
1. Rhinovirus, adenovirus, parainfluenza:
Clinical suspicion: Young, healthy. Adenovirus occurs in epidemics. May have associated URI symptoms.
Clinical suspicion: Winter epidemics. Myalgia and arthralgia. Unusual for fever to last for more than 5 days unless complicated.
3. Enterovirus, ECHO virus:
Clinical suspicion: Summer epidemics. Occasionally more distinct clinical picture.
5. Colorado tick fever (arbovirus).
2. Listeria monocytogenes:
Clinical suspicion: Depressed cell mediated immunity. ? have meningitis.
3. Salmonella typhi and paratyphi:
Clinical suspicion: Early BM and blood culture. Late stool culture.
Clinical suspicion: Low-grade fever.
- Past animal exposure
1. Coxiella Burnetti (Q fever):
Clinical suspicion: Infected livestock, retrobulbar headache.
2. Leptospira interrogans (leptospirosis):
Clinical suspicion: Water infected with the urine of cats, dogs.etc.
3. Brucella species:
Clinical suspicion: Contaminated dairy products. Serology and blood culture.
- Granulomatous infection
1. Mycobacterium TB:
Clinical suspicion: Could be disseminated disease, here a BM and live biopsy can yield high rate of organism. Could be due to renal involvement - sterile pyuria. Vertebral - back pain.
2. Histoplasmosis, malaria.
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