- Fever 238.°C (2101°F) on at least 2 occasions
- Illness duration of 23 weeks
- No known immunocompromised state
- Diagnosis that remains uncertain after a thorough history-taking, physical examination, obligatory and examinations
FUO
Organ Specific Bacterial Infection of FUO
- infectious endocarditis
- osteomyelitis
- occult abscess
- sinusitis
- cholangitis
- UTI
- meningitis
Non-Organ Specific Bacterial Infection of FUO
- brucellosis
- Q-fever
- SAlmonella
- Yersinia
- Tuleremia
- Septoc phlebitis
- rheumatic fever
- lyme disease
- TB
- Whipple’s disease
Organ Specific Viral Infection of FUO
- HIV
- CMV
- VIral hepatitis
- ENterovirus
Organ Specific Other Infection of FUO
- fungal
- protozoa (malaria)
- other parasites
Avoided drugs in FUO
- emperic therapeutic trials w/ antibiotics
- glucocorticoids/ antituberculosis agents
With an exception if the px is rapidly deteriorating
Irrevocably diminsh the ability to culture fastidious bacteria or mycobacteria
Antibiotics and Anti Tuberculosis Therapy
Good indication for empirical antibiotic therapy
Hemodynamic instability or neutropenia
If TST or IGRA is positive or if granulomatous disease is present with anergy and sarcoidosis seems inlukely
- Trial of therapy for tuberculosis should be started
Very difficult to obtain a rapid diagnosis
Miliary tuberculosis
If fever does not respond after 6 weeks of empirical antituberculosis treatment
Another dx should be considered
- Highly effective in preventing attacks of familial Mediterranean fever
- Remarkable improvements in the frequency and severity of subsequent febrile episodes within weeks- months
Colchicine
Response of adult onset Still’s disease is dramatic
NSAIDs
- Effects on giant cell arteritis and polymyalgia rheumatica are equally impressive
- Early empirical trials with glucocorticoids decrease the chances of reaching a diagnosis for which more specific and sometimes life saving treatment might more appropriate, such as malignant lymphoma
Glucocorticoids
Mask fever while permitting the spread of infection or lymphoma dictates that their use should be avoided unless infectious disease and malignant lymphoma have been largely ruled out and inflammatory disease is probable and is likely to be debilitating or threatening
NSAIDs, Glucocorticoids
Therapeutic trial can be considered in patients whose FUO has not been diagnosed after later stage diagnostic tests
Anakinra
account for most FUO related deaths
MAlignancy
