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Fever

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.

• Viral

1. Rhinovirus, adenovirus, parainfluenza:
Clinical suspicion: Young, healthy. Adenovirus occurs in epidemics. May have associated URI symptoms.

2. Influenza:
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.

4. Infectious mononucleosis syndromes (EBV, CMV).

5. Colorado tick fever (arbovirus).   

• Bacterial

1. Staphylococcus aureus septicemia:
Clinical suspicion: IV plastic cannulation, drug abusers. Must exclude endocarditis. Blood cultures.

2. Listeria monocytogenes:
Clinical suspicion: Depressed cell mediated immunity. ½ have meningitis.

3. Salmonella typhi and paratyphi:
Clinical suspicion: Early BM and blood culture. Late stool culture.

4. Streptococci:
Clinical suspicion: Low-grade fever.

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• 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.

4. Cat scratch disease:
Clinical suspicion: Small papule or pustule followed by painful lymph node enlargement.

• 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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