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

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.