pyrexia of unknown origin

Question 1

what is the definition of pyrexia of unknown origin ?

Answer 1

temp >38.3
recorded on multiple occasions
present for 3 weeks

no diagnosis after
3 outpatient visits
3 days in hospital
one week of outpatient investigation

Question 2

what are the different types of PUO ?

Answer 2

classical
nosocomial - develops in hospital
neutropenic - undiagnosed fever in <500/mm3 neutrophil
HIV - associated

Question 3

what are the common causes of PUO in HIV ?

Answer 3

TB ***
mycobacterium avium
unknown
more than one causative disease

Question 4

what is important in history taking of PUO ?

Answer 4

travel
occupation
hobbies
family history
past medical and surgical history
drug history
pattern of fever

Question 5

what should be examined in PUO ?

Answer 5

skin
eyes
oral cavities
nail and lymph

Question 6

what are general investigations for PUO ?

Answer 6

chest xray
U+Es
FBC, CRP, ESR, LFTs
blood cultures

Question 7

what are investigating for PUO in tropical travel ?

Answer 7

blood for malarial parasites, dengue, HIV
bone marrow for leishmaniasis
less likely if >21 days since return

Question 8

what are investigating for PUO in new murmurs ?

Answer 8

ECHO

Question 9

what are investigating for PUO in headaches ?

Answer 9

temporal artery biopsy

Question 10

what are investigating for PUO in microhaematuria ?

Answer 10

auto-antibodies +/- renal biopsy

USS

Question 11

TB contact

Answer 11

sputum smear
bone marrow
mantoux

Question 12

what are investigating for PUO in drug misuse ?

Answer 12

screen for BBV

Question 13

when can you use therapeutic trials in PUO ?

Answer 13

suspect TB - should improve in 2 weeks

temporal arteritis - should improve in 48 hours

Question 14

what are the outcomes of PUO ?

Answer 14

spontaneous resolution commoner in young people
some patients respond to NSAIDs or steroids
1/4 remain undiagnosed