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#FEVER OF UNKNOWN ORIGIN SKIN#

Tickborne relapsing fever (rodent-infested cabins)Ĭommon Causes of Fever in the Different Subclasses.

Periodic fever adenitis pharyngitis aphthous ulcer (PFAPA) syndrome.

Periarteritis nodosa/microscopic polyangiitis (PAN/MPA).

Adult Still disease (juvenile rheumatoid arthritis).

The list of causes is extensive, and it is broken down into broader categories, such as infection, noninfectious inflammatory conditions, malignancies, and miscellaneous. The causes of fever of unknown origin (FUO) are often common conditions presenting atypically. This article focuses on FUO in immunocompetent adult patients. It is important to note that immunocompromised and HIV patients may require an entirely different approach in diagnosing and treatment of recurrent fevers. In modern medicine, FUO remains one of the most challenging diagnoses. Despite extensive workup and diagnostic advances, up to 51% of FUO cases remain undiagnosed. Providers often order non-clue-based imaging and specific testing early in the FUO workup, which may be misleading and is certainly not economical. Over 200 malignant/neoplastic, infectious, rheumatic/inflammatory, and miscellaneous disorders can cause FUO.

#FEVER OF UNKNOWN ORIGIN SKIN#

Recommended investigations for work-up include complete blood count (CBC) with differential, three sets of blood cultures (from different sites, several hours apart, and before initiation of antibiotic therapy, if indicated), chest radiograph, complete metabolic panel (including hepatitis serologies if liver function tests are abnormal), urinalysis with microscopy and urine culture, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), antinuclear antibodies (ANA), rheumatoid factor (RA), cytomegalovirus IgM antibodies or virus detection in blood, heterophile antibody test, tuberculin skin test, HIV testing and computed tomography (CT) scan of the abdomen. Ī comprehensive history and physical examination can aid in diagnosis and direct diagnostic testing.

The revised definition proposed by Durack and Street in 1991 divided cases into four distinct subclasses: classic FUO, nosocomial FUO, neutropenic FUO, and HIV-related FUO. This definition was later changed to accommodate technological advances allowing for sophisticated outpatient evaluations, increasing numbers of immunocompromised individuals including those with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), and more complex treatment options becoming available. FUO was defined as a temperature of 101 degrees Fahrenheit (38.3 degrees Centigrade) or higher with a minimum duration of three weeks without an established diagnosis despite at least one week's investigation in the hospital. Review the importance of improving care coordination among interprofessional team members to improve outcomes for patients affected by fever of unknown origin.įever of unknown origin (FUO) was first described by Dr.Summarize the treatment of patients with fever of unknown origin.

Outline the causes for fever of unknown origin.

Describe the workup of a patient with a fever of unknown origin.

This activity reviews the cause and presentation of fever of unknown origin and highlights the role of the interprofessional team in its management. Today, due to technological advances allowing for sophisticated outpatient evaluations, the one-week inpatient investigation is no longer required. FUO was defined as a temperature of 101 degrees Fahrenheit (38.3 degrees Centigrade) or higher with a minimum duration of three weeks without an established diagnosis after an intensive one-week investigation in the hospital. Fever of unknown origin (FUO) was first described by Dr.