ChemPath: PUO Flashcards
Defined criteria commonly accepted definition of PUO
Durack and Street criteria
- Temperature >38.3
- Duration >3weeks
- Evaluation in at least 3 outpatient visits / 3 days hospital
What are the categories of PUO under the Durack and Street criteria?
What are the causes of classic PUO?
- Infection
- Malignancy
- Collagen vascular disease
What are the causes of nosocomial PUO?
- C. difficile enterocolitis
- Drug-induced
- Pulmonary embolus
- Septic thromboplebitis
- Sinusitis
What are some causes of immune deficient (neutropenic) PUO?
- Opportunistic bacterial infection
- Fungi - aspergillosis, candidiasis
- Herpes virus
What are some causes of HIV-associated PUO?
- CMV
- Mycobacterium avium-intracellulare complex
- Pneumocystis carinii pneumonia
- Drug-induced
- Kaposi sarcoma
History points for PUO
- B Symptoms (FLAWS), localising symptoms
- 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
What investigations for PUO?
Any others - speak to consultant (money)
What is the first line test in diagnosis of acute EBV infection?
Serum EBV IgM
What imaging and tissue diagnositic techniques might you employ in PUO?
Imaging
- FDG-PET (?cancer)
- Echocardiogram
Tissue
- Biopsy
- LP
- Bone marrow aspiration
When to order Echocardiogram in PUO?
?Infective Endocarditis - when the patient meets the Duke Criteria (2 major or 1 Major + 3 minor)
Describe the Duke Criteria for infective endocarditis.
What is required for diagnosis?
What are some infective causes of PUO?