Infectious Disease Book

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Fever of Unknown Origin

Aka: Fever of Unknown Origin, Fever of Undetermined Origin
  1. See Also
    1. Fever
  2. Types
    1. Classic Fever of Unknown Origin
      1. Daily or Intermittent Fever >= 38.3 C (101 F)
      2. Duration for 3 consecutive weeks
      3. No source by clinical evaluation
        1. Hospital evaluation for 3 days (previously 7) or
        2. Intensive outpatient evaluation for 7 days or
        3. Three outpatient visits
    2. Nosocomial Fever of Unknown Origin
      1. Daily or Intermittent Fever >= 38.3 C (101 F)
      2. Hospitalized >1 day without fever on admission
      3. Fever evaluation of 3 days of more
    3. Immune-Deficient Fever of Unknown Origin
      1. Daily or Intermittent Fever >= 38.3 C (101 F)
      2. Neutrophil Count <500 per mm3
      3. Fever evaluation of 3 days of more
    4. HIV-Associated Fever of Unknown Origin
      1. Daily or Intermittent Fever >= 38.3 C (101 F)
      2. Outpatient fever >4 weeks or
      3. Inpatient fever >3 days
  3. Causes
    1. See Fever of Unknown Origin Causes
    2. See Fever of Unknown Origin Causes by Age
    3. See Fever in the Returning Traveler
    4. See Drug-Induced Fever
  4. History
    1. See Fever of Unknown Origin History
  5. Physical Exam
    1. See Fever of Unknown Origin Examination
  6. Labs: First Line
    1. Complete Blood Count (CBC) with manual differential
    2. Erythrocyte Sedimentation Rate (ESR)
    3. Chemistry panel (e.g. Chem8)
    4. Liver Function Tests
    5. Blood Culture
    6. Urinalysis with Urine Culture
    7. Purified Protein Derivative (PPD)
    8. Chest XRay
    9. Consider CT Abdomen and Pelvis with contrast
      1. Source found in 19% of patients
  7. Subsequent Evaluation to consider
    1. Infectious cause suspected
      1. Second line tests
        1. AFB Sputum Cultures
        2. Rapid Plasmin Reagin (RPR)
        3. HIV Test
        4. ASO Titer
        5. Monospot
      2. Third line tests
        1. Transesophageal Echocardiogram
          1. Evaluate for endocarditis
        2. Lumbar Puncture
        3. Sinus CT
        4. Gallium 67 Scan
    2. Non-Hematologic Malignancy suspected
      1. Second line tests
        1. Mammogram
        2. Chest CT
        3. Upper endoscopy
        4. Lower endocscopy
        5. Gallium 67 Scan
      2. Third line tests
        1. Brain MRI
        2. Enlarged lymph node biopsy
        3. Skin lesion biopsy
        4. Liver biopsy
        5. Exploratory laparoscopy
    3. Hematologic Malignancy suspected
      1. Peripheral Smear
      2. Serum Protein Electrophoresis
      3. Consider Bone Marrow Biopsy
    4. Autoimmune condition suspected
      1. Rheumatoid Factor
      2. Antinuclear Antibody
      3. Consider temporal artery biopsy
      4. Consider lymph node biopsy
  8. Differential Diagnosis: Occult Bacteremia
    1. Consider hospitalization if fever >2 weeks
    2. Risk factors
      1. Age over 50 years
      2. Diabetes Mellitus
      3. Complete Blood Count: Leukocytosis and Left Shift
      4. Erythrocyte Sedimentation Rate >30
      5. Toxic appearance
      6. Immunocompromised patients
      7. Valvular heart disease
      8. Intravenous Drug Abuse
    3. References
      1. Mellors (1987) Arch Intern Med 147:666
  9. References
    1. Libman in Noble (2001) Primary Care Medicine, p. 194
    2. Mackowiak in Mandell (2000) Infectious Disease, p. 622
    3. Cunya (1996) Infect Dis Clin North Am 10:111-27
    4. Mourad (2003) Arch Intern Med 163:545-51
    5. Roth (2003) Am Fam Physician 68:2223-8

Fever of Unknown Origin (C0015970)

Definition (MSH) Fever in which the etiology cannot be ascertained.
Concepts Sign or Symptom (T184)
MSH D005335
ICD10 R50, R50.9
SnomedCT 206758001, 206764008, 158162001, 7520000
English Unknown Origin Fever, Unknown Origin Fevers, FEVER OF UNKNOWN ORIGIN, PUO Pyrexia of unknown origin, Pyrexia of unknown orig.NOS, Pyrexia of unknown origin NOS, [D]Fever of unknown origin, [D]Pyrexia of unknown orig.NOS, [D]Pyrexia of unknown origin, [D]Pyrexia of unknown origin NOS, Fever of unknown origin (F.U.O.), [D]Pyrexia of unknown origin (context-dependent category), [D]Pyrexia of unknown origin NOS (context-dependent category), fever of unknown origin, fever of unknown origin (diagnosis), fuo, [D]Pyrexia of unknown origin (situation), Fever of unknown origin (FUO), FEVER UNKNOWN ORIGIN, [D]Pyrexia of unknown origin NOS (situation), pyrexia of unknown origin, FUO, Fever of unknown origin [FUO], Fever of Unknown Origin [Disease/Finding], unknown origin fever, f.u.o., fever of unknown origin fuo, fever unknown origin, fever origin unknown, Fever;unknown origin, fevers unknown origin, Pyrexia;unknown origin, f u o, fevers origin unknown, fever of origin unknown, Pyrexia of unknown origin, F.U.O., Fever of unknown origin, PUO - Pyrexia of unknown origin, Pyrexia of unknown origin (finding), PUO; febris, febris; PUO, fever; unknown origin, hyperpyrexia; unknown origin, unknown origin; fever, unknown origin; hyperpyrexia, Fever of Unknown Origin
Dutch pyrexie van onbekende oorsprong, koorts van onbekende oorsprong, e.c.i.; febris, febris; e.c.i., hyperpyrexie; onbekende oorsprong, koorts; onbekende oorsprong, onbekende oorsprong; hyperpyrexie, onbekende oorsprong; koorts, Koorts door onbekende oorzaak
French Pyrexie d'origine inconnue, Fièvre d'origine inconnue
German Pyrexie unbekannter Ursache, Fieber unbekannter Ursache, Fieber unbekannter Genese
Italian Febbre di origine ignota, Piressia di origine sconosciuta, Febbre di origine sconosciuta
Portuguese Pirexia de origem desconhecida, Febre de origem desconhecida, Febre de Causa Desconhecida
Spanish Pirexia de origen desconocido, Fiebre de origen desconocido, [D]pirexia de origen desconocido (categoría dependiente del contexto), [D]pirexia de origen desconocido, SAI (categoría dependiente del contexto), [D]Pyrexia of unknown origin, [D]pirexia de origen desconocido, SAI, [D]pirexia de origen desconocido, SAI (situación), [D]pirexia de origen desconocido (situación), [D]pirexia de origen desconocido, fiebre de origen desconocido (hallazgo), fiebre de origen desconocido, F.O.D., Fiebre de Origen Desconocido
Japanese 不明熱, フメイネツ
Swedish Feber av okänt ursprung
Czech horečka neznámého původu, Horečka neznámého původu, Pyrexie neznámého původu
Finnish Epäselvä kuume
Russian LIKHORADKA NEIZVESTNOI ETIOLOGII, ЛИХОРАДКА НЕИЗВЕСТНОЙ ЭТИОЛОГИИ
Korean 기타 및 원인 미상의 열
Polish Gorączka idiopatyczna, Gorączka o nieznanej etiologii
Hungarian Ismeretlen eredetű láz
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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