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  • Pyrexia of Unknown Origin

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    Haziq Kamardin
    20 vizualizări17 pagini
    Pyrexia of unknown origin (PUO) is defined as a fever above 38.3°C on multiple occasions for more than 3 weeks without an identifiable cause. Common causes in western countries are infections (20-25%) and non-infectious inflammatory diseases like vasculitis. Outside the west, infections like tuberculosis account for 43% of cases. Atypical presentations of common diseases are a frequent cause of PUO, such as atypical endocarditis. In the elderly, PUO is usually caused by an unusual manifestation of a common illness like giant cell arteritis presenting without vision changes. Neoplasms, especially lymphomas, are another important cause of PUO.

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    Pyrexia Of Unknown Origin

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    Pyrexia of unknown origin (PUO) is defined as a fever above 38.3°C on multiple occasions for more than 3 weeks without an identifiable cause. Common causes in western countries are infections (20-25%) and non-infectious inflammatory diseases like vasculitis. Outside the west, infections like tuberculosis account for 43% of cases. Atypical presentations of common diseases are a frequent cause of PUO, such as atypical endocarditis. In the elderly, PUO is usually caused by an unusual manifestation of a common illness like giant cell arteritis presenting without vision changes. Neoplasms, especially lymphomas, are another important cause of PUO.

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    20 vizualizări17 pagini

    Pyrexia of Unknown Origin

    Încărcat de

    Haziq Kamardin
    Pyrexia of unknown origin (PUO) is defined as a fever above 38.3°C on multiple occasions for more than 3 weeks without an identifiable cause. Common causes in western countries are infections (20-25%) and non-infectious inflammatory diseases like vasculitis. Outside the west, infections like tuberculosis account for 43% of cases. Atypical presentations of common diseases are a frequent cause of PUO, such as atypical endocarditis. In the elderly, PUO is usually caused by an unusual manifestation of a common illness like giant cell arteritis presenting without vision changes. Neoplasms, especially lymphomas, are another important cause of PUO.

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    din 17

    Pyrexia Of

    Unknown
    Origin
    (PUO)
    What is fever?

    Fever is an elevation of body temperature that exceeds


    the normal daily variation and occurs in conjunction with
    an increase in the hypothalamic set point [eg., 37 Celcius
    to 39 C]

    NORMAL VALUE:
    36.5 37.5 C
    (97.7 99.5 F)
    Pyrexia of Unknown
    Origin (PUO)
    Definition

    Petersdorf and Beeson (1961)


    Temperatures of >38.3C (>101F) on several occasions
    A duration of fever of >3 weeks
    Failure to reach a diagnosis despite 1 week of inpatient
    investigation

    New definition
    Same criteria as earlier definition
    Three outpatient visits or 3 days in the hospital without
    elucidation of a cause or 1 week of "intelligent and invasive"
    ambulatory investigation
    New classification of
    PUO By: Durack and Street

    Nosocomial
    Classic PUO
    PUO

    HIV-
    Neutropenic
    associated
    PUO
    PUO
    Epidemiology & Etiology

    Western countries
    Infection (20-25% )
    Neoplasms
    Non-infectious inflammatory diseases (NIIDs) collagen/rheumatic
    disease, vasculitis or granulomatous syndrome
    Increase percentage of undiagnosed cases of PUO

    Areas outside the West


    Infections (43%) about 50 % of it is d/t tuberculosis
    Neoplasms
    NIIDs
    Possible causes of PUO
    A common disease presenting in atypical way
    A common disease presenting in atypical way

    1. Infections

    Common Rare

    Atypical presentation of Q fever by bacteria Coxiella


    endocarditis, burnetti (d/t exposure to
    animals or animal product) lives
    diverticulitis, vertebral in rural area, breath in dust
    osteomyelitis, extra- contaminated by infected
    pulmonary TB animals
    Malaria, leishmaniasis, Whipples disease -
    histoplasmosis, unexplained CNS, GIT, joints
    coccidiodomycosis symptoms
    history of travel to endemic
    area
    2. Non-infectious Inflammatory Diseases (NIIDS)

    Common Rare
    Large vessel vasculitis Hereditary auto-
    Polymyalgia rheumatica inflammatory
    syndromes young
    Sarcoidosis patients
    Familial Mediterranean fever Schnitzlers syndrome
    Adult-onset Stills disease any age, urticaria, bone
    (fever, joint pain, bumpy rash) pain, weight loss, malaise,
    fatigue,
    hepatosplenomegaly
    3. Neoplasms

    Most common cause of PUO in neoplasm is malignant


    lymphoma fever precedes lymphadenopathy on
    physical examination
    4. Miscellaneous
    Exercise-induced hyperthermia
    Elevated body temperature that is
    Drug induced fever associated with moderate to strenuous
    Drug reaction with eosinophilia & systemic exercise [half an hour to several hours]
    symptoms]: eosinophilia + lymphadenopathy without increase in CRP level/ESR
    Allopurinol Factitious fever
    Carbamazepine (fever artificially induced by patient)
    Common in young woman in health care
    Lamotrigine
    professions
    Phenytoin (easy access to thermometer and
    Sulfasalazine drugs,manipulation)
    Furosemide Fraudulent fever
    Antimicrobial drugs sulphonamides, minocycline,
    (patient is normothermic but
    vancomycin, B-lactam antibiotics, isoniazid
    manipulates the thermometer) do
    Antiretroviral- nevirapine simultaneous measurements at different body
    CVS drugs (e.g.: Quinidine ) sites diagnosis.

    Dissociation between pulse rate & temperature


    In Elderly, PUO usually results from an atypical manifestations
    of a common disease:
    1. Giant cell arteritis (ex; no reduced in visual acuity) / Polymyalgia
    rheumatica (no shoulder stiffness)
    2. TB-negative sputum smears
    References

    Harrisons 19th ed. Volume 1 Chapter 18 page 158-164


    Davidsons 22nd ed. page 296-299

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