Fever of unknown origin

Broad-spectrum IV antibiotics should be initiated or added at the time of the first neutropenic fever under the treatment guidelines endorsed by the Infectious Disease Society of America for management of fever of unknown origin in the neutropenic host.89... 

FUO Fever of unknown origin HRSD Hamilton Rating Scale for Depression... 

Most children born with HIV are asymptomatic. On physical examination, they often present with unexplained physical signs such as lymphadenop-athy, hepatomegaly, splenomegaly, failure to thrive, and weight loss or unexplained low birth weight, and fever of unknown origin. Laboratory... 

The diagnosis (definite or possible endocarditis) according to the 1992 Duke s criteria (see Mandell et al., 2000) is based on blood cultures and echocardiography, the patient s history and findings upon physical examination. This diagnosis should always be considered in patients presenting with fever of unknown origin, especially when they also have a heart murmur and/or normocytic, normochromic anemia. 

Treatment can be of shorter duration when there is granulocyte recovery. When fever of unknown origin remains high despite 4 days of broad spectrum antibiotics, antibiotics are stopped and new cultures of blood are done. Antiviral or antifungal therapy must then be considered. 

Holtz, T., Moseley, R.H., Scheiman, JJM. Liver biopsy in fever of unknown origin. A reappraisal. X Clin. Gastroenterol. 1993 17 29—32... 

Solis-Herruzo, J.A., Benlta, V, Morillas, J.D. Laparoscopy in fever of unknown origin — study of seventy cases. Endoscopy 1981 13 207 - 210... 

Martino R, Subira M, Domingo-Albos A, Sureda A, Brunet S, Sierra J. Low-dose amphotericin B hpid complex for the treatment of persistent fever of unknown origin in patients with hematologic malignancies and prolonged neutropenia. Chemotherapy 1999 45(3) 205-12. 

Schoffski P, Freund M, Wunder R, Petersen D, Kohne CH, Hecker H, Schubert U, Ganser A. Safety and toxicity of amphotericin B in glucose 5% or Intrahpid 20% in neutropenic patients with pneumonia or fever of unknown origin randomised study. BMJ 1998 317(7155) 379-84. 

Osterwalder P, Koch J, Wuthrich B, Pichler WJ, Vetter W. Unklarer status febrilis. [Intermittent fever of unknown origin.] Dtsch Med Wochenschr 1998 123(24) 761-5. 

Felbamate is currently reserved for patients who are refractory to other drugs after careful consideration of the benefitrharm balance. In some countries the indication has been restricted to refractory Lennox-Gastaut syndrome. It is wise to avoid felbamate in patients with previous blood dyscrasias or autoimmune disorders, especially lupus erythematosus. Before they start to take it, patients should be informed about the potential risks and early symptoms of bone-marrow toxicity, such as bruisability, petechiae, fever of unknown origin, weakness, and fatigue. Hematology tests should be performed at baseline and during treatment, and dose escalation should be slow. 

A 56-year-old woman with acute promyelocytic leukemia developed a fever of unknown origin, weight gain of 5 kg, and respiratory distress 9 days after the start of treatment with tretinoin 45 mg/m (38). Her white cell count rose to 21 x 10 /1 despite treatment with cytosine arabinoside and idarubicin. A chest X-ray showed bilateral alveolar opacities. She recovered fully after 5 days of treatment with dexamethasone 10 mg bd. 

Blau IW, Eauser AA. Review of comparative studies between conventional and liposomal amphotericin B(Ambisome) in neutropenic patients with fever of unknown origin and patients with systemic mycosis. Mycoses 2000 43 325-32. 

Mackowiak PA, Durach DT. Fever of unknown origin. In Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas and Bennett s Principles and Practice of Infectious Diseases, 5th ed. New York, Churchill-Livingstone, 2000 622-633. 

Clinical Applications. Lipophilic Tc-exametazime has been shown to label leukocytes without affecting cell viability (Mortelmans et al. 1989 Peters et al. 1986 Roddie et al. 1988). HMPAO-labeled leukocytes have been used to locate site(s) of focal infection (e.g., abdominal abscess, abdominal sepsis) (Kelbaek et al. 1985) it is also indicated in conditions of fever of unknown origin, and in conditions not associated with infection such as inflammatory bowel disease (Arndt et al. 1993 Lantto et al. 1991). Labeled leukocytes have offered superior information when compared with bone scanning for the detection of osteomyelitis in children (Lantto et al. 1992). In a retrospective study in 116 patients with infection suspected to involve orthopedic implants, osteomyelitis, and septic arthritis, HMPAO-labeled leukocytes have been an effective tool in the diagnosis of chronic osteomyelitis and joint infection involving implants (sensitivity > 97%, specificity > 89%) (Devillers et al. 1995). 

Q fever is probably endemic in Somalia,12 and serologic evidence of acute Q fever was identified in two American soldiers evaluated in Somalia for fever of unknown origin.11,13... 

Should the infant exhibit an elevated temperature or other signs of infection or sepsis, the physician should promptly and thoroughly evaluate the fever of unknown origin. Accordingly, the ears, upper respiratory tract, lungs, urinary tract, and any surgical wounds must be completely examined. If no source of systemic infection can be detected, the intravenous tubing and bottle or bag of nutrient solution should be cultured and replaced. 

Infections occurred clinically most frequently in the arm veins, and were found in 10% of the cases. On the basis of 4.000 bacteriological investigations the catheter tips were contaminated in 16.37o, skin swabs were positive in 22%, and irrigation fluid from removed catheter contained bacteria in 11.5%>. The frequency of bacterial contamination of a caval catheter depends on the primary disease, local infections, the technique of catheter placement and care and the time the catheter stayed in place. Therefore, catheters should not be used longer than absolutely necessary. If there is evidence of skin or vein irritation or fever of unknown origin the catheter should be removed immediately. 

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