Fever of Unknown Origin Flashcards
Define FUO
documented fever for at least 3 weeks w/ fever >38.3 C (100.94F) and of undetermined etiology after 1 week of investigation in hospital
infectious causes of fever
- infective endocarditis
- intra-abdominal infections
- osteomyelitis
- infected peripheral blood vessels
- TB
- kidney infection, UTI, urosepsis
neoplastic causes of fever
- solid tumors: kidney; hepatoma
- lymphoreticular malignancy: hodgkin’s and non-hodgkin’s lymphoma
hematologic causes of fever
- adult onset Stills Dz
- Temporal Arteritis (GCA) - polymyalgia rheumatic
- vasculitis syndromes: PAN and Wegener’s
- Seropositive Dz: SLE and RA
misc. causes of fever
- facticious (Munchausen)
- Drug fever: abx, barbiturates, antiarrythmics, dilantin
- sarcoidosis
- IBD
taking a hx for FUO
- travel
- occupation
- hobbies
- exposure to animals
- known infectious contacts
- drug use
- family hx
- surgical hx
PE for FUO
- confirm actual fever
- assess the pattern of fever
- a COMPLETE PE
lab and imaging to consider for FUO
- CBC w/ smear (diff)
- ESR, CRP, serum calcitonin
- lytes and LFTs = CMP
- blood C&S
- urine C&S, UDS
- LP - CSF for C&S if neuro sxs present
- CXR
- abdominal US
What are the MC infection etiologies of sepsis in adults?
- pneumonia
- abdominal infection
- kidney infection
- bloodstream infection (bacteremia)
define UTI
bacteriuria in the presence of sx
4 age groups at increased risk for UTI
- neonates
- girls
- young women
- older men
given appropriate UTI sx, what is the best diagnostic standard?
positive results on urine culture of >1000cfu/ml
define pyelonephritis
-infection of the renal parenchyma w/ clinical syndrome of flank pain or CVA tenderness in associated w/ fever, chills, prostration, n/v
what indicates urethritis in males?
- dysuria w/ a urethral dischage
- STDs MC cause in young adults
- e.coli MC cause in older males
nl UA results
-RBCs for female
0-5 rbcs/hpf
nl UA results
-RBCs for male
0-3 rbcs/hpf
nl US results
- WBC
- bacteria
- leukocyte esterase
- nitrite
- WBC: 0-4 wbcs/hpf
- no bacteria
- no leukocyte esterase in dipstick test
- no nitrites
summary of a nl UA
- positive nitrite or leukocyte esterase supports diagnosis of UTI
- but negative test result doesn’t exclude it
tx of acute cystitis in adult female
nitrofurantoin 100 mg BID x 7 days
tx of pyelonephritis in adult female
-cipro 500 mg BID x 10-14 days
or
-amoxil/clavulanic acid 875 mg BID x 10-14 days
tx of young male adult with cystitis
tx for STD w/ cephtriaxone 250 mg IM + azithromycin 1 g PO single dose
tx of older male adults with cystitis
tx for e. coli with cipro 500 mg BID x 7 days
empiric tx for inpatient management of pyelonephritis and complicated UTI
- cipro 400mg IV BID
- ceftriaxone (rocephin) 1g IV daily
- cefotaxime 1-2g IV q8 hrs
- pip-tazo (zosyn) 3.375mg IV q6
- cefepime 2g IV q8 hrs
how does urosepsis typically present?
- fever
- chills
- lethargy
- altered mental status
- sx of the underlying infection: dysuria, flank pain
