Pyrexia of Unknown Origin Flashcards
Definition of Nosocomial PUO
Develops in hospital after 3 days
Definition of Neutropenic PUO
Undiagnosed fever in patient with neutrophils <500/mm3
Definition HIV-associated PUO
Fever in a patient with a HIV infection - present and undiagnosed for more than three days in an inpatient or four weeks in an outpatient
What is a fever
Elevation of body temperature above normal (37)
What are Pyrogens
Substances which cause fever
Petersdorf and Beeson 1961 definition of PUO
Temp >38.3
Recorded on multiple occasions
Present for at least 3 weeks
Defied diagnosis after one week of hospital evaluation
What is the modern definition of PUO
Pyrexia for ≥3 weeks with no identified cause after evaluation in hospital for 3 days or ≥3 outpatient visits.
What Ix would you order for PUO with someone who had been on rent tropical travel
Blood for malarial parasites
Dengue
What Ix would you order in someone with PUO who had a new murmur
ECHO
Transoesophageal may be needed
What Ix would you consider in someone with PUO who had a headaches
Temporal artery biopsy
or
CT PET
What Ix would you order in someone with PUO who has been in contact with TB
Sputum smear
Bone marrow biopsy
Mantoux
What Ix would you consider in someone with PUO who has been misusing drugs
Screen for blood-borne viruses
What Ix would you consider in someone with PUO who has micro-haematuria
Auto-antibodies +/- renal biopsy
USS
What are the potential outcomes of PUO
Spontaneous resolution of PUO commoner in younger patients
Some patients with no diagnosis response to NSAIDs or steroids
Regular re-appraisal required
What is steroid responsive PUO
When there is no diagnosis but the patient responds to steroid treatment regardless
