Pyrexia Of Unknown Origin Flashcards
What is PUO?
Pyrexia of unknown origin is when there is no diagnosis for after 3 outpatient visits or 3 days in hospital or 1 week of outpatient investigations
Classifications: classical, nosocomial (develops in hospital), neutropenia (neutrophils <500), HIV associated
What are the major disease categories which can present with PUO?
Classical: infection, neoplasm, inflammatory
HIV associated: mycobacterium tuberculosis, mycobacterium avium
What is the approach to the PUO patient?
History - good
Examination - thorough
Investigate - urinalysis + microscopy, CXR, FBC, WCC, CRP, ESR, blood cultures, u+e, creatinine, LFTs
Further investigation depends on history and indication eg travel, headaches, drugs
May do invasive investigations eg tissue samples, bone marrow
What imaging is available for use in investigation of PUO?
Valuable if have direction
- CT scan
- CTPET
- USS
What is the place of the therapeutic trial in PUO patients?
Rarely used (last resort), more for suspected mycobacterium infection, suspected vasculitis or connective tissue disorder
Usually spontaneous resolution in the young, may respond to steroids or NSAIDs