Pyrexia of Unknown Origin Flashcards
1
Q
Pyrexia of Unknown Origin
A
- Body T varies over 24 hours (low in morning, high in evening)
Temperature greater than 38 degrees on multiple occasions (3 outpatient visits) or for a prolonged period (3 days in hospital)
2
Q
Pyrogens
A
Substances that cause fever
- Exogenous: endotoxins of bacteria (gram -ve)
- Endogenous: cytokines from host cell
- Target: thermoregulatory centre in hypothalamus
- Mechanism: vasoconstriction of peripheral vessels
3
Q
Types of PUO
A
- Classical: non-compromised
- Nosocomial: in-hospital
- Neutropenic: neutrophil <500
- HIV-associated
4
Q
Causes of PUO
A
- Malignancy: lymphoma, Hodgkin’s, RCC, HC, leukaemia
- Inflammatory: IBD, osteomyelitis, discitis
- Infection: endocarditis, abscess
- Collagen: CT disorders (temporal arteritis), vasculitis
- Miscellaneous: multiple PE, factitious fever, drug fever
- Undiagnosed
- HIV-related: HIV infection, lymphomas, Mycobacterium TB/avium
5
Q
PUO: Patient History
A
- Travel
- Occupation/hobbies
- PMH
- Drug
- Sexual
- Familial disorders
- Pattern of fever
- Rashes
- Myalgia, weight loss, arthralgia, shivers
6
Q
PUO: Examination
A
Repeated important
- Complete
- Skin
- Eyes, fundi
- Oral cavity
- Nails
- Lymph nodes
7
Q
PUO: Preliminary investigations
A
- CXR
- Urinalysis/microscopy
- FBC and WCC
- CRP and ESR elevation
- Blood cultures x3
- Urea, creatinine, electrolytes, LFTs
8
Q
PUO: Further investigations
A
- Tropical travel associated
- Echocardiogram (new murmur)
- Biopsy e.g. headache
- Autoantibodies
- Sputum culture, Mantoux test
- Blood-borne viruses (IVDU)
- Laparoscopy
9
Q
PUO: Imaging
A
Exclude bacterial sepsis/malignancy
- CT/MRI/CT PET
- Scintigraphy (WC labelled)
- Isotope bone scan
- VQ scan
- Ciprofloxacin radiolabelled
10
Q
PUO Management
A
Therapeutic trial if still unclear
- Anti-TB therapy
- Steroids
11
Q
Fabricated fever
A
Real but self-induced
- Continues despite illness
- Psychiatric expertise
