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Pyrexia of unknown origin

From Mediwikis

Prolonged fever of > 2 week duration, fever repeatedly above 38 °C, with unclear evaluation after 3 days in hospital, or one week in the outpatient setting.

Causes

50% are infective, 15% are due to connective tissue disorders, 10% malignancy and 20% are undiagnosed.

Infection

Malignancy

  • Lymphoma- Hodgkins/ Non-Hodgkins
  • Leukaemia
  • Renal Cell Carcinoma

Others

History

Different patterns of fever, and the corresponding disease they may relate to
  • Associated symptoms
  • Duration and pattern of fever
  • Contacts
  • Travel
  • Food/Water
  • Sexual contact
  • Medication
  • Animal contact

Examination

  • Organomegaly
  • Signs of inflammation
  • Rashes
  • Cardiac signs (murmurs)

Investigations

Aggressive investigation leads to better outcomes. Empirical treatment is rarely successful

  • Multiple blood cultures
  • FBC, CRP/ESR, U&E, LFT
  • Imaging- CXR, AXR, CT, US
  • Bone marrow biopsy
  • Tuberculin tests