FEVER OF
UNKNOWN
ORIGIN(FUO)
Presented by Anjitha K J, Intern
DEFINITION – by Peterdorf and Beeson in
1961
“ Temperature more than 38.3°C (101°F),
lasts for more than 3 weeks and failure to reach
a diagnosis, even after 1 week of inpatient
investigations “
Definition in 2003 stated that failure to get
a diagnosis after 3 days of inpatient
investigations or 3 outpatient visits should
qualify the term FUO.
CLASSIFICATION OF FUO
Four categories
1. Classic
2. Nosocomial
3. Neutropenic
4. Human immunodeficiency virus (HIV)
associated
Nosocomial
- fever above 38.3°C (101°F)
- lasting for more than 72 hours
- developing in a hospitalized patient due to a
process not present or incubated at the time of
admission.
- Most common causes are pneumonia, urinary
tract infection (UTI), catheter related infections.
Clostridium difficile colitis, cytomegalovirus (CMV)
infection, sinusitis, septic thrombophlebitis and
pulmonary embolism
Neutropenic
- fever more than 38.3°C (101°F)
- lasting for more than 72 hours in a patient
- with absolute neutrophil count less than 500/m²
or expected to reach that level in 1-2 days.
-Most commonly this is produced by bacterial
infections-bacteremias, pneumonia and soft tissue
infections.
Human Immunodeficiency Virus
Associated – Fever is a common
accompaniment of HIV infection
- most common agents : Mycobacterium
tuberculosis, Myco. avium complex,
Pneumocystis carinii etc..
Classic FUO – all cases of FUOs other than
nosocomial , neutropenic and HIV associated
FUOs
ETIOLOGY
Infections – include Occult TB, Intra
abdominal infections, other infections, Viral
infections, Fungal infections
Malignancy
Autoimmune diseases
Miscellaneous
Undiagnosed
COMMON CAUSES OF PROLONGED FEVER
Infections ( 40%)
1. Bacterial
Abscesses – Prev. abdominal or pelvic
surgery, trauma or history of diverticulosis or
peritonitis increases the likelihood of an occult
intra- abdominal abscess
- MC ly in the subphrenic space, liver, right
lower quadrant, retroperitoneal space or the
pelvis in women
TB – should be suspected in all pts
suffering from c/c resp ds esp if associated
with
-night sweats, Evening rise of temperature
, emaciation, and hemoptysis and family
history or/& past clinical history.
-Cough persisting for more than 2 weeks
without obvious causes also can suspect for
TB ,
Investigations – Sputum smear
examination
RBE – ESR high ( > 100 active TB ),
- Mantoux test – positive if the diameter of
the induration exceeds 12m
[Link] - fever with chills, severe irritative
bladder s/ms such as urgency, frequency,
hesitancy, dysuria, strangury with or without
hematuria
Investigations : Pyuria in urine analysis
Presence of bacteria can also be detected
Urine culture
3. Infective endocarditis – low grade or high
grade intermittent or continous fever, often
associated with chills and rigor ,
[Link] infections - eg. cholangitis
can develop without local signs and with only
mildly elevated or normal liver function tests
esp in elderly
[Link] - Usually causes localized pain or
discomfort atleast sporadically
[Link] - persistent fever and a history of
contact with cattle,swine,goats or sheep or pts who
consume raw milk pdts
[Link] fever - Continous or remittent fever -it rises
in step ladder pattern in 1st week with
headache,malaise
widal test used for the diagnosis
[Link] recurrentis - transmitted by ticks and is
responsible for relapsing fever
FACTITIOUS FEVER
Elevation of temparature, self induced by
patients with psychological problems