Chapter 019. Fever of Unknown Origin (Part 3) ppt

For example, in Japan, human T cell lymphotropic virus type I is a consideration; in China, infection plays a greater role and tuberculosis is prominent; and in Spain, visceral leishmani

Chapter 019 Fever of Unknown Origin

(Part 3)

Source: From a study of 347 patients referred to the National Institutes of

Health from 1961 to 1977 with a presumptive diagnosis of FUO of >6 months' duration (R Aduan et al Prolonged fever of unknown origin Clin Res 26:558A, 1978)

More than 200 conditions may be considered in the differential diagnosis of classic FUO in adults; the most common of these are listed in Table 19-3 This list applies strictly to the United States Geographic considerations are paramount For example, in Japan, human T cell lymphotropic virus type I is a consideration; in China, infection plays a greater role and tuberculosis is prominent; and in Spain, visceral leishmaniasis may be a more common cause of FUO The frequency of global travel underscores the need for a detailed travel history, and the continuing emergence of new infectious diseases makes this listing potentially incomplete The possibility of international and domestic terrorist activity involving the

intentional release of infectious agents, many of which cause illnesses presenting with prolonged fever, underscores the need for obtaining an insightful environmental, occupational, and professional history, with early notification of public health authorities in cases of suspicious etiology (Chap 214)

Table 19-3 Causes of FUO in Adults in the United States

Infections

Localized pyogenic infections

Appendicitis

Cat-scratch disease

Cholangitis

Cholecystitis

Dental abscess

Diverticulitis/abscess

Lesser sac abscess

Liver abscess

Mesenteric lymphadenitis

Osteomyelitis

Pancreatic abscess

Pelvic inflammatory disease

Perinephric/intrarenal abscess

Prostatic abscess

Renal malacoplakia

Sinusitis

Subphrenic abscess

Suppurative thrombophlebitis

Tuboovarian abscess

Intravascular infections

Bacterial aortitis

Bacterial endocarditis

Vascular catheter infection

Systemic bacterial infections

Bartonellosis

Brucellosis

Campylobacter infection

Cat-scratch disease/bacillary angiomatosis (B henselae)

Gonococcemia

Legionnaires' disease

Leptospirosis

Listeriosis

Lyme disease

Melioidosis

Meningococcemia

Rat-bite fever

Relapsing fever

Salmonellosis

Syphilis

Tularemia

Typhoid fever

Vibriosis

Yersinia infection

Mycobacterial infections

M avium/M intracellulare infections

Other atypical mycobacterial infections

Tuberculosis

Other bacterial infections

Actinomycosis

Bacillary angiomatosis

Nocardiosis

Whipple's disease

Rickettsial infections

Anaplasmosis

Ehrlichiosis

Murine typhus

Q fever

Rickettsialpox

Rocky Mountain spotted fever

Mycoplasmal infections

Chlamydial infections

Lymphogranuloma venereum

Psittacosis

TWAR (C pneumoniae) infection

Viral infections

Colorado tick fever

Coxsackievirus group B infection

Cytomegalovirus infection

Dengue

Epstein-Barr virus infection

Hepatitis A, B, C, D, and E

Human herpesvirus 6 infection

Human immunodeficiency virus infection

Lymphocytic choriomeningitis

Parvovirus B19 infection

Fungal infections

Aspergillosis

Blastomycosis

Candidiasis

Coccidioidomycosis

Cryptococcosis

Histoplasmosis

Mucormycosis

Paracoccidioidomycosis

Pneumocystis infection

Sporotrichosis

Parasitic infections

Amebiasis

Babesiosis

Chagas' disease

Leishmaniasis

Malaria

Strongyloidiasis

Toxocariasis

Toxoplasmosis

Trichinosis

Presumed infections, agent undetermined

Kawasaki's disease (mucocutaneous lymph node syndrome)

Kikuchi's necrotizing lymphadenitis

Neoplasms

Malignant

Colon cancer

Gall bladder carcinoma

Hepatoma

Hodgkin's lymphoma

Immunoblastic T-cell lymphoma

Leukemia

Lymphomatoid granulomatosis

Malignant histiocytosis

Non-Hodgkin's lymphoma

Pancreatic cancer

Renal cell carcinoma

Sarcoma

Benign

Atrial myxoma

Castleman's disease

Renal angiomyolipoma

Habitual Hyperthermia

(Exaggerated circadian rhythm)

Collagen Vascular/Hypersensitivity Diseases

Adult Still's disease

Behçet's disease

Erythema multiforme

Erythema nodosum

Giant-cell arteritis/polymyalgia rheumatica

Hypersensitivity pneumonitis

Hypersensitivity vasculitis

Mixed connective-tissue disease

Polyarteritis nodosa

Relapsing polychondritis

Rheumatic fever

Rheumatoid arthritis

Schnitzler's syndrome

Systemic lupus erythematosus

Takayasu's aortitis

Weber-Christian disease

Wegener's granulomatosis

Granulomatous Diseases

Crohn's disease

Granulomatous hepatitis

Midline granuloma

Sarcoidosis

Miscellaneous Conditions

Aortic dissection

Drug fever

Gout

Hematomas

Hemoglobinopathies

Laennec's cirrhosis

PFPA syndrome: periodic fever, adenitis, pharyngitis, aphthae

Postmyocardial infarction syndrome

Recurrent pulmonary emboli

Subacute thyroiditis (de Quervain's)

Tissue infarction/necrosis

Inherited and Metabolic Diseases

Adrenal insufficiency

Cyclic neutropenia

Deafness, urticaria, and amyloidosis

Fabry disease

Familial cold urticaria

Familial Mediterranean fever

Hyperimmunoglobulinemia D and periodic fever

Muckle-Wells syndrome

Tumor necrosis factor receptor–associated periodic syndrome

Type V hypertriglyceridemia

Thermoregulatory Disorders

Central

Brain tumor

Cerebrovascular accident

Encephalitis

Hypothalamic dysfunction

Peripheral

Hyperthyroidism

Pheochromocytoma

Factitious Fevers

"Afebrile" FUO (<38.3°C)

Source: Modified from RK Root, RG Petersdorf, in JD Wilson et al (eds):

Harrison's Principles of Internal Medicine, 12th ed New York, McGraw-Hill,

1991