1094900
Description
Mind Map by LewisLewis, updated more than 1 year ago
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Created by LewisLewis
over 10 years ago
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Fevers of unknown origin (FUO)
- With increasing duration of fever of unknown origin,
decreases the probability that it is caused by an infection
- Non-fever
- Most frequently found in young women
- It does not exceed 37.5° (axillary measurement)
- No pathological significance, with physiological
accentuation of the physiological circadian rhythm
- Most frequently found in young women
- Triggered fever
- Frequently observed in children or adolescents of both sexes
- Found in individuals with special behavioral characteristics such
as hypersensitivity, fragility, but also cunning and temerity
- Motivating factor is usually a difficult moment in school or family
- Frequently observed in children or adolescents of both sexes
- Fever of unknown origin (FUO)
- Definition
- Temperature > 38.3°C
- Fever lasting > 3 weeks
- Failure of any attempt to justify the diagnosis of
febrile symptoms after a week research hospital
- Temperature > 38.3°C
- Causes
- Infectious
- Extrapulmonary tuberculosis
- Malaria
- Mononucleosic syndromes
- Endocarditis
- Fungal infections
- Extrapulmonary tuberculosis
- Non infectious
- Hematologic malignancies
- Solid tumors
- Immunological diseases
- Granulomatous diseases
- Extensive tissue necrosis with resorption of pyrogenic
substances (heart attacks, pulmonary thromboembolism)
- Hemorrhage
- Hemolysis
- Replacement diseases and metabolic diseases
- Endocrinopathies
- Hypersensitivity to drugs
- Direct, local stimulation, of the thermoregulatory
centers (eg. tumor or cerebral hemorrhage)
- Hematologic malignancies
- Infectious
- The most useful and fast criterion is the anamnesis, with the search and
evaluation of the symptomatology, followed by the 1st level examinations
- Classification
- Classical
- T > 38.3°
- Duration of > 3 wk
- Evaluation of ≥ 3 visits or 3 d in hospital
- Leading causes
- Cancer
- Infections
- Inflammatory conditions
- Undiagnosed
- Cancer
- T > 38.3°
- Nosocomial
- Leading causes
- Nosocomial infections (e.g. from C. difficile)
- Postoperative complications
- Drug-induced fever
- Deep vein thrombosis (DVT)
- Nosocomial infections (e.g. from C. difficile)
- Characteristics
- T > 38.3°
- Patient hospitalized ≥ 24h, fever not
present or incubating on admission
- Evaluation of at least 3 d
- T > 38.3°
- Leading causes
- Neutropenic (immune deficient)
- Common agents involved
- Bacteria
- Fungi (Candida and Aspergillus)
- Bacteria
- Characteristics
- T > 38.3°
- Absolute neutrophil count ≤ 500 per mm3
- Evaluation of at least 3 d
- T > 38.3°
- Common agents involved
- HIV associated
- Causes
- Majority due to opportunistic infections
- Mycobacteria, CMV, toxoplasma,
Pneumocystis jirovecii, Cryptococcus
- Mycobacteria, CMV, toxoplasma,
Pneumocystis jirovecii, Cryptococcus
- Tumors
- IRIS
- HIV infection itself
- Characterized by fever, rash and lymphadenopathy in 40-70% of patients
- Characterized by fever, rash and lymphadenopathy in 40-70% of patients
- Majority due to opportunistic infections
- Fever is either continuous or recurrent
- The use of HAART has reduced the incidence of HIV-associated FUO
- Characteristics
- T > 38.3°
- Duration of > 4 wk for outpatients, > 3 d for inpatients
- HIV infection confirmed
- T > 38.3°
- Causes
- Classical
- Opportunistic infections
- The relative frequency of each cause of
FUO is influenced by many factors, such as:
- Counts of CD4+
- Viral load
- Geographical context and local
prevalence of certain infectious agents
- Counts of CD4+
- The relative frequency of each cause of
FUO is influenced by many factors, such as:
- Diagnosis
- Anamnesis
- At first you should exclude
the 3 minor causes of FUO
- Factitious fever: assess the fever personally
- Usual hypertermia: establish an appropriate thermal curve
- Drug-induced fever
- Factitious fever: assess the fever personally
- At first you should exclude
the 3 minor causes of FUO
- Physical evaluation
- Associated symptoms
- Fever + rash: Rickettsial, borreliosis
- Fever + jaundice: hepatitis, colangitis
- Fever + lymphadenopathy: HIV, EBV, CMV, lymphoma
- Fever + diarrhea: HIV, intestinal parasites
- Fever + urinary frequency/dysuria/stranguria: UTI
- Fever + pain: localized abscess
- Fever + pathological pulmonary examination: TB
- Fever + localized or diffuse myoarthralgias: borreliosis
- Fever + rash: Rickettsial, borreliosis
- Fundoscopical evaluation
- Infectious endocarditis
- HIV (HIV retinopathy)
- CMV (CMV retinitis is the most common retinal
infection in patients with advanced HIV infection)
- Toxoplasmosis
- Cryptococcosis
- Infectious endocarditis
- Skin lesions or mucous membrane lesions
- Abnormal masses
- Enlarged masses
- Painful points
- Associated symptoms
- Lab and instrumental examinations
- First-level exams
- Blood count with formula
- Study of lymphocyte subsets (CD4+, CD8+)
- Standard urinalysis (with evaluation of the sediment)
- Inflammatory indices
- Markers of organ function
- Indicators of immunologic disorders
- Multi-test Merieux
- QuantiFERON, Mantoux test with tuberculin PPD
- Cultures and serological tests
- Full serology for hepatitis virus infection
- Blood count with formula
- Second-level exams
- Third-level exams (invasive)
- Biopsies
- Endoscopy (gastroscopy, colonoscopy, broncos copy with BAL)
- Exploratory laparoscopy
- Biopsies
- First-level exams
- Ex adiuvantibus diagnosis
- Anamnesis
- Definition
- Evaluation of the type of fever
- Malaria: rarely typical with prophylaxis
- Cyclic neutropenia
- Fever and neutropenia every 21 days
- Fever and neutropenia every 21 days
- Horgkin's disease
- Familial Mediterranean fever (FMF)
- Familiarity, association with sierositis
- Familiarity, association with sierositis
- Malaria: rarely typical with prophylaxis
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