ChemPath: PUO Flashcards
Defined criteria commonly accepted definition of PUO
(Pyrexia of known definition
Durack and Street criteria
Temperature >38.3, Duration >3weeks, Evaluation in at least 3 outpatient visits / 3 days hospital
Other Categories of PUO in Durack criteria
Nosocominal
Patient hospitalised >24 hrs but no fever on admission
Immune deficient
Neutrophil count <500 per mm^3
HIV associated
Common Nosocomial causes of PUO
C.Diff
Drug induced
Pulmonary embolus
Septic thromboplebitis
Sinusitis
HIV related causes of PUO
CMV
Mycobacterium avium-intracellulare complex
Pneumocystis carinii pneumonia
Kaposi sarcoma
History points for PUO
- B Symptoms - FLAWS
- Medications Doses & initiation date
- Contact history - pets / animals
- Drug use
- Sexual history
- Foreign Travel
Points to ask on Hx of Foreign Travel
- Specific Village/ City?
- What they did there
- Where they stayed
- Others infected
- Walking barefoot?
- Mosquito Nets
Test to consider in all PUO
HIV
(consent needed)
Exclude malaria in patient with tropical travel in last 2 years
Is an Interferon Gamma release assay (IGRA) useful in diagnosing TB
No
Doesnt tell you much for active TB
Routine Investigations for PUO
A&E
FBC
U&E
LFT
CRP
CXR
Blood Cultures
Urine Dip
Medic
2x Blood Cultures
Urine Culture
Stool Culture + OCP (Ova, cysts paracites)
CMV/EBV serology
HIV / HBV / HCV
CK
Ferritin
LDH
ANCA
ANA
RhF
TFT
Any others - speak to consultant (money)
Best scan for Cancer?
FDG-PET
(Fluorescently lablled Glucose - uptake and localisation of tumour)
When to order Echocardiogram in PUO
?Infective Endocarditis =
When the patient meets the Duke Criteria
2 major or [1 Major + 3 minor]
Major criteria of Duke Criteria
Persistent bacteraemia (>2 BC positive)
Echocardiogram: Vegetation
Positive Serology for bartonella, Coxiella or Brucella
Minor Criteria for Duke Criteria
Predisposition (murmur, IVDU)
Inflammatory Markers (Fever, CRP high)
Immune complexes (splinters / RBC in urine)
Embolic Phenomena (Janeway lesions, Olsers)
1 positive BC
Where is Schistosomiasis commonly found
Africa - along the Nile Delta
Infective Causes of PUO
Viral
CMV, EBV
HIV
Hepatitis ABCDE
Fungal
Cryptococcosis
Histoplasmosis
Paracites
Malaria
Amoebic LIver abcess
Schistosomiasis
Toxoplasmosis
Bacterial
Q Fever, Bartonella, Brucella
Mycobacteria - TB / NTM
Eneteric Fevers
Zoonoses