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Back to Infections Symptoms
Fever
A. Fever without localizing symptoms, rash or lymphadenopathy
ii. Those with fever beyond 3 weeks (FUO)
Definition: Fever of unknown origin (FUO) is a term applied
to a febrile illness with temperatures exceeding >101?F (38.3?C) that
is at least 3 weeks' duration and remains undiagnosed after 3 days in
the hospital or after 3 outpatient visits. This is further categorized
into:
1. Neutropenic (neutrophils </= 500):
check for perianal, periodontal infections and candidemia, aspergillosis.
2.
HIV associated: mycobacterium avium,
mycobacterium TB,
non-Hodgkin's lymphoma, drug fever and
CMV.
3. Nosocomial FUO: septic thrombophlebitis,
clostridium difficile colitis and drug fever.
4. Classic FUO:
infections,
malignancies,
inflammatory diseases and drug fever.
a. Infections: account for 1/3 of
the causes.
Abscesses account for 1/3 of the causes. Most of these
are intra-abdominal as abscesses, abscesses elsewhere are easily diagnosed.
Mycobacterial infections.
CMV,
EBV in the young.
Lower urinary tract infections.
Endovascular infections:
infective endocarditis, mycotic
aneurysms, infected atherosclerotic plaques.
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b.
Malignancy: accounts for 1/3 of
the causes. Leukemia and
hypernephroma releases endogenous pyrogens.
Hepatocellular carcinoma
and liver metastasis can also present with fever. Atrial myxoma.
c. Collagen vascular diseases: account
for 10%. SLE is an uncommon cause as it is readily diagnosed serologically.
d. Granulomatous disease without defined
etiology (e.g.
sarcoidosis).
e. Miscellaneous:
Crohn's disease,
familial Mediterranean fever, hypertriglyceridemia, drug related and
recurrent pulmonary embolism.
f. Factitious:
1. Thermometer in the tea cup routine.
2. Self-injection with pyrogenic containing substances.
3. Injection of medication known by the patient to
cause fever.
g. Undiagnosed.
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