Fever of Unknown Origin Flashcards
Define FUO
- Temperatures of >38.3°C (101°F) on several occassions
- Duration of fever of > 3 weeks
- Failure to reach diagnosis despite 1 week of inpatient investigation
Neutropenic FUO
Temperature of >38.3 °C (>101 °F) on several occasions in a patient whose neutrophil count < 500/uL or is expected to fall to that level in 1-2 days
Classic FUO
3 outpatient visits or 3 days in the hospital without elucidation of a cause
Nosocomial FUO
Temp >38.3°C (>101 °F) on several occassions in hospitalized (acute care infection not manifested) or incubating on admission
MUST: 3 days investigation (2 days incubation of culture)
HIV associated FUO
Temperature of >38.3 °C (>101 °F) on several occassions over a period of >4 weeks for outpatients or 3 days for hospitalized patients with HIV infection
Infections
Leading diagnosable cause of FUO
Most frequent cause of FUO in the Elderly
o Multisystem disease (Giant cell arteritis leading)
Causes of FUO lasting > 6 months
None identified MIsc Factitious Granulomatous hepatitis Neoplasm Still's disease Infection Collagen vascular disease Familial mediterranean fever
ESR, leukocytosis, and anemia and is often accompanied by arthralgias, polyserositis (pleuritis, pericarditis), lymphadenopathy, splenomegaly, and rash.
still’s disease
examine the terminal ileum and cecum
o Upper GI contrast w/ small-bowel follow-through and colonoscopy
systemic necrotizing vasculitis is suspected
arteriography
cause FUO nosocomial
50% - infectious cause
25% - noninfectious cause
20% - undiagnosed.
empiric coverage of neutropenic FUO
vancomycin plus ceftazidime or
cefepime or,
carbapenem with or without an aminoglycoside
Indication for empirical therapy with fluoroquinolone plus piperacillin
Vital sign instability
Neutropenia
ID pneumocystis infection
67-Ga scan
