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3rd Year Infection > Pyrexia of Unknown Origin > Flashcards

Pyrexia of Unknown Origin Flashcards

1
Q

How is fever defined?

A

Body temp >37
Variation up to 0.8C daily
Part of the systemic inflammatory response syndrome

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2
Q

How are pyrogens defined?

A

Substances which cause fever

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3
Q

What are the pyrogens?

A

Endogenous - cytokines

Exogenous - endotoxines from G-ve bact

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4
Q

How is Pyrexia of Unknown Origin defined?

A

3 outpatient visits/3 days in hospital with no diagnosis

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5
Q

What is nosocomial PUO?

A

Develops in hospital

Undiagnosed after 3 days

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6
Q

What is neutropenic PUO?

A

Undiagnosed fever in Pt with neutrophils <500/mm3

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7
Q

What is HIV-associated PUO?

A

Fever in patient with HIV and fever (without diagnosis) present for >3days in hospital/4 weeks outpatient

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8
Q

What are the causes of HIV-related PUO?

A

Mycobacterium tuberculosis (21%)
Mycobacterium avium (18%)
Unknown (16%)
>1 cause (20%)

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9
Q

How is PUO assessed?

A

History - travel, hobbies, history, past medical history, drugs
Examination - repeat often necessary, full body

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10
Q

How is PUO investigated?

A 
CXR
Urinalysis/microscopy
FBC/WCC
CRP/ESR
Blood cultures during fever
U+E, LFTs
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11
Q

PUO with tropical travel should be investigated how?

A

Blood for malaria, dengue, HIV

Bone marrow for leishmaniasis

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12
Q

Tropical infection is more likely with PUO when?

A

If >21 days since return

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13
Q

PUO with new murmur should be investigated how?

A

Echocardiogram

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14
Q

PUO with headaches should be investigated how?

A

Superficial tempral artery biopsy

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15
Q

PUO with micro haematuria should be investigated how?

A

Autoantibodies +/- renal biopsy

Ultrasound

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16
Q

PUO with TB contact should be investigated how?

A

Sputum smear
Bone marrow
Mantoux

17
Q

PUO with IVDA should be investigated how?

A

Blood-borne illnesses

18
Q

What imaging is used in PUO?

A

White cell scan
PET scan
Fluorodeoxyglucose marker
Ultrasound

19
Q

What invasive investigations are used for PUO?

A

Tissue for culture + histology

Bone marrow and liver

20
Q

How is PUO treated?

A

Therapeutic trial (vasculitis, mycobacterium)
TB unlikely if no response within 2 weeks
Temporal Arteritis responds within 2 days

21
Q

What is fabricated fever?

A

Fever real, self induced - self injection
Patient continues despite being very sick
Seek psychiatric expertise

22
Q

What are the outcomes of PUO?

A

Spontaneous resolution more common in young
Some respond to NSAIDs/steroids
Re-appraisal required

3rd Year Infection (16 decks)

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