Infectious FUO Flashcards
FUO Criteria
Fever >/= 38.3 on at least 2 occasions
Illness >/ = 3 weeks
No known immunocompromised state
Dx remains uncertain after thorough hx and PE
Obligatory lab investigations to rule in FUO
Inflammatory markers (ESR, CRP) Leukocyte and differentials
Most common cause of FUO
Dx
TB - 50%
Tuberculin skin test
RPR-A
2nd most common cause of FUO
Non-infectious inflammatory disease
Collagen, rheumatic, vasculitis
Most common diagnosis of FUO among neoplasm
Malignant lymphoma
Repeated episodes of fever interspersed with fever-free interval of at least 2 weeks w apparent remision of underlying disease
Recurrent fever
Fever artifically induced by patient by IV injection of contaminated water
Factitious fever
Manipulation of thermometer
Dissociation between pulse rate and temperature
Per degree raise in temp 10-20 inc in HR
Fraudulent fever
Drug induced fever DRESS drugs (Drug Reaction with Eosinophilia and Systemic Symptoms)
Allopurinol Carbamazepine Phenytoin Sulfasalazine Lamotrigine Furosemide Sulfonamide Minocycline Vancomycin B lactam
Do not perform >3 blood cultures of >1 urine culture in px without
possible diagnosis
Miliary TB do
Liver biopsy for AFB smear
Culture
PCR
If fever persists more than 3 days after discontinuation of suspected drug,
it is unlikely that drug is the cause
Useful in early dx workup in those without PDC or misleading PDC
Fundoscopy
FUO tx
Empirical antibiotics Antituberculous therapy (+ TST or PRA) Colchicine NSAID Glucocorticoids Anakinra IL 1 antagonist
New criteria in Harrison’s 19 vs 20th
4: Obligatory investigation
