Approach to pyrexia of unknown origin

The differential for fever of unknown origin is vast, but resist the urge to order every test available in your hospital. Pyrexia of unknown origin puo is a syndrome that has long tested the. Most cases are caused by common problems presenting in unusual ways. A comprehensive evidencebased approach to fever of unknown. Fever of unknown origin fuo in children approach to. Pyrexia of unknown origin has been defined as fever for more than 3 weeks where no cause is found despite seven days of basic investigations in hospital. Pyrexia of unknown origin radiology reference article. Overview of fever of unknown origin metabolic disorders.

Normal body temperature the hypothalamus is the heatregulating center of the body the normal body temperature ranges from 37. Pediatric fever of unknown origin american academy of. The focused fever of unknown origin diagnostic approach is based on hall. Pyrexia of unknown origin puo is defined as fever of 38. The diagnostic approach to fever of unknown origin in cats t rue fever pyrexia is defined as an increase in body temperature due to an elevation of the thermal set point in the anterior hypothalamus secondary to the release of pyrogens. Control and supervision of a specialist during the course of therapy is mandatory this, above all, is the key to a speedy recovery. Broadly speaking, the three most common causes are infection, neoplasia, and connective tissue disease. The definition of fever of unknown origin fuo, as based on a case series of 100 patients,3 calls for a temperature higher than 38. By definition, patients included in this syndrome will be more difficult to diagnose as they have already. Infection pyrexia of unknown origin puo r rudd the americans use the more appealing term, fever of unknown origin fuo.

Although the traditional causes of fever of unknown origin fuo are increasingly rare, fuos are not. Introduction pyrexia of unknown origin puo, also known as fever of unknown origin fuo, is a grouping of many unrelated medical conditions that share the feature of persist. The fuo workup is directed by a careful history, physical exam, and focused diagnostic tests and procedures. Fever of unknown origin fuo was defined in 1961 by petersdorf and beeson as the following. Pediatricians often confuse fever without a source and fever of unknown origin. Current clinical topics in infectious diseases, remington js, swartz mn eds, blackwell science, boston 1991. Approach to the adult patient with fever of unknown origin. Modern approach to pyrexia of unknown origin pyrexia of unknown origin dr. Approach to the adult with fever of unknown origin uptodate. If the cause is found it is usually a diagnosis of exclusion, that is, by eliminating all possibilities until only one explanation remains, and taking this as the correct one. Postoperative pyrexia teachmesurgeryteachmesurgery. The definitions include a duration of fever of any thing from 1 to 3 weeks,1 but rigid adherence to these leads to a constipated approach.

Pyrexia of unknown origin has a wide differential diagno. It is important to distinguish children with fever without source from children with pyrexia of unknown origin. Pyrexia of unknown origin in patients with hiv infection can be caused by hiv seroconversion, opportunistic infections at low cd4 cell count levels especially immune reconstitution inflammatory syndrome iris after commencing antiretroviral therapy. Clinical approach to fever of unknown origin in children sciencedirect. Clinical approach to fever of unknown origin in children. The definition of pyrexia of unknown origin puo dates back to 1961.

Fever of unknown origin fuo was initially defined as a temperature 38. Pyrexia of unknown origin definition of pyrexia of. Investigating and managing pyrexia of unknown origin in. The new fuos are often found among patients in intensive care units, many of whom are already r. Clinicians commonly refer to a febrile illness without an initially obvious etiology sometimes called fever without localizing signs as fever of. Pyrexia of unknown origin history taking geeky medics. The approach to diagnostic study is best guided by ongoing assessment for historical, physical, and basic laboratory clues. After completing this article, readers should be able to. The diagnostic approach to fever of unknown origin in cats. The diagnostic approach to fever of unknown origin in dogs t rue fever pyrexia is defined as an increase in body temperature due to an elevation of the thermal set point in the anterior hypothalamus secondary to the release of pyrogens. The initial definition proposed by petersdorf and beeson in 1961,1 later revised, is a fever of 38. Few clinical problems generate such a wide differential diagnosis as pyrexia fever of unknown origin. Fever of unknown origin requires a specific approach and often nonstandard treatment regimens. The term fever of unknown origin fuo in pediatrics has had varying definitions in the literature, with duration of fever ranging, depending on the definition, from 5 to 21 days.

The evaluation section of the definition was later revised to at least 3 outpatie. Fever of unknown origin is one of the supreme diagnostic challenges in medicine. Fever of unknown origin fuo identifies a syndrome of fever that does not resolve spontaneously, in which the cause remains elusive after an extensive. Approach to management,singapore medical journal 2005 vol 36. Department of pediatrics, lin shin medical corporation lin shin hospital, taichung, taiwan. Pyrexia of unknown origin puo is defined as a recurrent fever 38 o c persisting for 3wks without an obvious cause, despite 1wk of inpatient investigation causes of puo include infection of unknown source 30%, malignancy classically bsymptoms from lymphoma, 30%, connective tissue diseases or vasculitis 30% and drug reactions. Pyrexia of unknown origin guideline introduction in the paediatric population, pyrexia of unknown origin puo is described as fever of.

The syndrome of pyrexia of unknown origin puo was first defined in 1961 but remains a clinical challenge for many physicians. Assessment of fever of unknown origin in adults approach. Most febrile illnesses either resolve before a diagnosis can be made or develop distinguishing characteristics that lead to a diagnosis. This approach is more difficult when the clinical features are few, subtle, or insufficient to characterise a disease or group of diseases. About 20% of patients with documented fuo never have a confirmed diagnosis. The etiology of fuo varies markedly among different age groups, geographic areas, and seasons.

Investigating and managing pyrexia of unknown origin in adults. These patients are said to have fever of unknown origin fuo. By definition, patients included in this syndrome will be more difficult to diagnose as they have already resisted classification during baseline investigations. Characteristic history and physical examination findings together with. Failure to reach a diagnosis after one week of inpatient investigation. Background fever of unknown origin fuo is defined as a temperature higher than 38. Puerperal pyrexia is defined as the presence of a fever in a woman, within six weeks of giving birth. Pyrexia of unknown origin puo is defined as a temperature of 38. The diagnostic approach to fever of unknown origin in dogs. A pyrexia of unknown origin, commonly shortened to puo and also known as a fever of unknown origin fuo, was originally defined in 1961 as the condition in which the core body temperature is 38. Fever of unknown origin fuo in adults is defined as a temperature higher than 38. A comprehensive evidencebased approach to fever of. Pdf laparoscopic approach to fever of unknown origin.

However, in a hospital with the full availability of sophisticated diagnostic techniques, a reduced period of two weeks with unexplained oral temperatures of 38 degrees centigrade or more has. This could be expanded to include the elderly as a fifth group. Different subgroups with puo have been suggested, each requiring different investigative strategies. Pyrexia of unknown origin puo fever of unknown origin fuo more commonly used in literatures. The syndrome of fever of unknown origin fuo was defined in 1961 by petersdorf and beeson as the following. The diagnostic approach may be slower in generally well patients because fever often resolves during the evaluation process. Broad laboratory testing is often more harmful than helpful. The most frequently encountered underlying causes of the pyrexia are listed in box 2. Pyrexia of unknown origin puo is a syndrome that has long tested the skills of physicians to achieve a diagnosis in affected patients. Diagnosis often involves pattern recognitionfor example, thyrotoxicosis or rheumatoid arthritis commonly have a constellation of distinctive clinical features and laboratory tests are then done for confirmation. Fever of unknown origin definition fever of unknown origin fuo refers to the presence of a documented fever for a specified time, for which a cause has not been found after a basic medical evaluation.

Fever of unknown origin or fever of too many origins. The history and physical are the foundation for your ddx development and subsequent testing strategy. Adopt a systematic approach to evaluation and management of fever of unknown origin in patients of various ages. Infections account for 40%, neoplasms 20% and collagen vascular diseases 15% of cases. Clinicians commonly refer to a febrile illness without an initially obvious etiology sometimes called fever without localizing signs as fever of unknown origin fuo.