Pyrexia of unknown origin in clinical practice

SUMMARY Fever of undetermined origin (FUO) is a challenging entity with a striking presence in hospitals around the world. It is defined as temperature ≥ 37.8 ° C on several occasions, lasting ≥ three weeks, in the absence of diagnosis after three days of hospital investigation or 3 outpatient visits. The main etiologies are infectious, neoplastic, and non-infectious inflammatory diseases. The diagnosis is based on the detailed clinical history and physical examination of these patients, in order to direct the specific complementary tests to be performed in each case. The initial diagnostic approach of the FUO patient should include non-specific complementary exams. Empirical therapy is not recommended (with few exceptions) in patients with prolonged fever, as it may disguise and delay the diagnosis and conduct to treat the specific etiology. The prognosis encompasses mortality of 12-35%, varying according to the baseline etiology.

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“…They are neutropenic, hospitalized (nosocomial FUO), HIV positive, elderly patients and children. 11,13,[20][21][22][23][24]…”

Section: Discussionmentioning

confidence: 99%

Fever of unknown origin in special groups

Santana

Rodrigues

Silva

et al. 2019

Rev. Assoc. Med. Bras.

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“…A fever of unknown origin is pragmatically defined as a febrile illness lasting longer than 2 weeks without an explanation. This is provided they are not being treated for an infection and three blood cultures and cross-sectional imaging are negative 29. One other consideration is a bone marrow biopsy, especially in the context of (hepato)splenomegaly or peripheral lymphadenopathy 30…”

Section: Fevermentioning

confidence: 99%

Evidence-based out-of-hours hospital medicine

McKenzie

2018

Postgraduate Medical Journal

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Out-of-hours (OOH) hospital ward cover is generally provided by junior doctors and is typified by heavy workloads, reduced staff numbers and various non-urgent nurse-initiated requests. The present inefficiencies and management problems with the OOH service are reflected by the high number of quality improvement projects recently published. In this narrative review, five common situations peculiar to the OOH general ward setting are discussed with reference to potential areas of inefficiency and unnecessary management steps: (1) prescription of hypnotics and sedatives; (2) overnight fluid therapy; (3) fever; (4) overnight hypotension and (5) chasing outstanding routine diagnostic tests. It is evident that research and consensus guidelines for many clinical situations in the OOH setting are a neglected arena. Many recommendations made herein are based on expert opinion or first principles. In contrast, the management of significant abnormalities in outstanding blood results is based on well-established guidelines using high-quality systematic reviews.

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“…A bone marrow biopsy, in particular, revealed that the known cause of PUO is existence of lymphoma. 6 Until a definitive diagnosis is made, treatment of PUO should be carefully considered. Few limitations were placed on the use of steroids and antibiotics because they mask the symptoms of the underlying disease.…”

Section: Introductionmentioning

confidence: 99%

The role of bone marrow biopsy in patients with pyrexia of unknown origin

Jabeen

Farooq

Naeem³

et al. 2022

J Fatima Jinnah Med Univ

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Background: Pyrexia of unknown origin (PUO) is a major complication which remains undiagnosed. Different diagnostic test were used to arrive at final investigation. Bone marrow biopsy (BMB) plays a vital role in diagnosis of PUO. The objective of current study was to determine the role of bone biopsy in diagnosing various types of causes of pyrexia of unknown origin. Patients and methods: A prospective cross-sectional study was conducted from 1st September 2018 to 28th February 2019 at Department of Hematology, Combined Military Hospital Lahore, Pakistan. The data of 120 patients who were remained undiagnosed for at least 1 week were enrolled. Standard procedures were used to obtain the biopsy specimens and bone marrow aspiration was sent for microbiological examination. All the demographic information was kept on a structured self-designed proforma. Data was entered and analyzed using SPSS v.24. Results: Out of 120 patients recruited in the study there were 67 (55.8%) were from age group 16 to 35 years, were males (65.8%) and 65.0% patients were suffering from fever for more than 3 days. The majority of the participants (30%) were diagnosed with infections, fever due to reactive changes (10.0%), acute leukemia (14.2%), lymphoma (11.7%), chronic leukemia (10.0%), aplastic anemia (4.2%), multiple myeloma (2.5%) and 11.7% patients were undiagnosed Conclusion: In the diagnosis of pyrexia of unknown origin, morphological and histological investigation of bone marrow plays a vital role. However, if it is combined with other diagnostic modalities such as radiological, microbiological, and serological examinations, the efficiency of diagnosis can be improved.

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Pyrexia of unknown origin in clinical practice

Abstract: This article revisits concepts of pyrexia of unknown origin to reflect current clinical practice. It describes the evolution of the term, in line with the changing spectrum and pace of investigations, and introduces key questions that may be used to evaluate a pyrexia of unknown origin.

Cited by 8 publications

References 18 publications

Fever of unknown origin in special groups

Fever of unknown origin in special groups

Evidence-based out-of-hours hospital medicine

The role of bone marrow biopsy in patients with pyrexia of unknown origin

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