Fever Of Unknown Origin Flashcards
originally defined as an illness of >3 weeks’ duration with fever of ≥38.3°C (≥101°F) on two occasions and an uncertain diagnosis despite 1 week of inpatient evaluation.
FUO
FUO isnow defined as follows:
- Fever ≥38.3°C (≥101°F) on at least two occasions
- Illness duration of ≥3 weeks
- No known immunocompromised state
- Diagnosis that remains uncertain after a thorough history-taking,physical examination, and the following obligatory investigations:
(ESR) and C reactive protein (CRP) level; platelet count; leukocyte count and differential; measurement of levels of hemoglobin, electrolytes, creatinine, total protein, alkaline phosphatase, alanine aminotransferase,aspartate aminotransferase, lactate dehydrogenase, creatine kinase,ferritin, ANA, and rheumatoid factor; protein electrophoresis; urinalysis; blood cultures (n = 3); urine culture; chestx-ray; abdominal ultrasonography; and tuberculin skin test (TST) orinterferon γ release assay (IGRA).
(defined as repeated episodes of fever interspersed with fever-free intervals of at least 2 weeks and apparent remission of the underlying disease), the chance of attaining an etiologic diagnosis is <50%.
recurrent fever
is by far the most common diagnosis of FUO among the neoplasms.
malignant lymphoma
is the most common infectiousdisease associated with FUO in elderly patients, occurring much moreoften than in younger patients.
Tuberculosis
can present at any age, is Uncommon but can often be diagnosed easily in a patient with FUO who presents with urticaria, bone pain, and monoclonal gammopathy
Schnitzler syndrome
is characterized by an elevated body temperature that is associated with moderate to strenuous exercise lasting from half an hour up to several hours WITHOUT an-increase in CRP level or ESR; typically these patients sweat during the-temperature elevation
Exercise-induced hyperthermia
(fever artificially induced by thepatient—for example, by IV injection of contaminated water) should beconsidered in all patients but is more common among young women in health care professions
Factitious fever
the patient is normothermic but manipulates the thermometer. Simultaneous measurements at Different body sites (rectum, ear, mouth) should rapidly identify this diagnosis.
Another clue is a dissociation betweenpulse rate and temperature
fraudulent fever,
FUO in the elderly results from an atypical manifestation of a common disease, among which two of which are most frequently involved
giant cell arteritis and polymyalgia rheumatica
FUO with headache should prompt microbiologic examination of cerebrospinal fluid(CSF) for organisms including
herpes simplex virus (especiallytype 2), Cryptococcus neoforman
Mycobacterium tuberculosis.
True or false:
In central nervous system tuberculosis, the CSF typically has elevated Protein and lowered glucose concentrations, with a mononuclear pleocytosis.
True
A TST is included in the obligatory investigations, but it may yield false negative results in patients with
miliary tuberculosis
malnutrition
immunosuppression
If fever persists beyond how many hours after-discontinuation of the suspected drug, it is unlikely that this drug is the cause
72 hours
When the first-stage diagnostic tests do-not lead to a diagnosis,____ should be performed, especiallywhen the ESR or the CRP level is elevated.
scintigraphy
True or false:
In patients with recurrent fever lasting >2 years,it is very unlikely that the fever is caused by infection or malignancy
True
accumulates in tissues with a high rate of glycolysis, which Occurs not only in malignant cells but also in activated leukocytes and thus permits the imaging of acute and chronic inflammatory processes.
FDG or Fluorodeoxyglucose
True of false
temporal artery biopsy is still recommended for patients ≥55 years of age in a later stage of thediagnostic protocol
True
True or false:
FDG-PET/CT will not be useful in vasculitis limited to the temporal arteries because of the small diameter of these vessels and the high levels of FDG uptake in the brain
True
Because FDG-PET/CT is highly sensitive in detecting these 3 diseases , the value of bone marrow biopsy as a screening procedure is probably further reduced
lymphoma
carcinoma
osteomyelitis
Giant cell arteritis often involves large arteries and in most cases can be diagnosed by
FDG-PET /CT
True or false
Empirical therapeutic trials with antibiotics, glucocorticoids, oral antituberculous agents should be avoided in FUO except when a patient’s condition is rapidly deteriorating after the aforementioned diagnostic tests have FAILED to provide a definite diagnosis.
True
If the fever does not respond after how many weeks of empirical antituberculous treatment, another diagnosis be considered
6 weeks of ptb Tx
is highly effective in preventing attacks of familial Mediterranean fever but is not always effective once an attack is well under way
Colchicine
a recombinant Form of the naturally occurring IL-1 receptor antagonist (IL-1Ra),blocks the activity of both IL-1α and IL-1β. It is extremely effective in the treatment of many autoinflammatory syndromes,such as familial Mediterranean fever, cryopyrin-associated periodic syndrome, tumor necrosis factor receptor–associated periodic syndrome, mevalonate kinase deficiency (hyper IgD syndrome) and Schnitzler syndrome
Anakinra
