pyrexia of unknown origin n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
PYREXIA OF UNKNOWN ORIGIN PowerPoint Presentation
Download Presentation
PYREXIA OF UNKNOWN ORIGIN

Loading in 2 Seconds...

play fullscreen
1 / 30

PYREXIA OF UNKNOWN ORIGIN - PowerPoint PPT Presentation


  • 811 Views
  • Uploaded on

PYREXIA OF UNKNOWN ORIGIN. Dr. Alaa Jumaa. PUO is A Common disease presenting ATYPICALLY. Terminology . Old Definition : Petersdorf and Beeson (1961) Fever higher than 38.3 o C on several occasions. Duration of fever – 3 weeks

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'PYREXIA OF UNKNOWN ORIGIN' - hector-skinner


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide2
PUO is

A Common disease presenting ATYPICALLY

terminology
Terminology
  • Old Definition: Petersdorf and Beeson (1961)
    • Fever higher than 38.3oC on several occasions.
    • Duration of fever – 3 weeks
    • Uncertain diagnosis after one week of study in hospital
  • New Definition:
    • Eliminated the in-hospital evaluation requirements → 3 outpatient visits, or 3 days in hospital. … Ambulatory as well as in hospital
epidemiology and etiology
Epidemiology and Etiology
  • 1970 → up to date:

Infection is the most frequent.

  • 1930 → 70% undiagnosed PUO
  • 2000 → 5-10% undiagnosed PUO
    • Diagnostic Advances:

Modify the spectrum of PUO causing diseases:

      • Serology: HIV / Brucella / SLE
      • Imaging Tech: Abscesses/Solid Tumor
slide9

Geography

J Postgrad Med 2001; 47(2):104-107

diagnostic approach
Diagnostic Approach
  • Careful History
  • Physical Examination (repeated)
  • Diagnostic Testing
history
History
  • Verify the presence of fever:
    • Series of 347 patients → for prolonged fever → 35% were ultimately: a. No fever

b. Factitious Fever

  • Duration of Fever:
    • The longer the duration → the less likely to have infection and malignancy.
history1
History

A history of exposure to wild or domestic animals should be solicited (zoonotic disease )

Ingestion of dirt is a particularly important clue to infection with Toxoplasma gondii (toxoplasmosis).

Ancestry from the Mediterranean should suggest the possibility of familial Mediterranean fever (FMF).

history2
History
  • Travel:
    • Travel to an area known to be endemic for certain disease:
      • Name of the area, duration of stay
      • Onset of illness … (incubation period)
history3
History
  • Drug and Toxin History:
    • almost all drug can cause drug fever …
    • Antihistamine
    • beta lactam
    • anti-TB …
    • Salicylates and other NSAID …
    • eye drops, which may be associated with atropine-induced fever.
history4
History
  • Localizing Symptoms:
    • May Indicate the source of fever:
history5
History
  • Family History:
    • search for possible infectious or hereditary disorders
      • Tuberculosis
      • FMF
  • Past Medical Condition:

Lymphoma → may recur

Rheumatic Fever → may recur

physical examination
Physical Examination
  • Document the Fever:
    • Significant and persistent for more than ONE occasion.
  • Analyzing the Pattern:
    • Neither specific Nor sensitive enough to be considered diagnostic … EXCEPT

Tertian & Quarter Pattern → Malaria

Pel-Ebstein Pattern → Lymphoma/Tuberculosis

Pulse-Temp Dissociation → Typhoid/Brucellosis

physical examination1
Physical Examination
  • Sweating in a febrile child should be noted
    • familial dysautonomia, or exposure to atropine.
  • A careful ophthalmic examination is important
  • Hyperemia of the pharynx, with or without exudate, suggests
    • infectious mononucleosis, CMV infection, toxoplasmosis, salmonellosis ,Kawasaki disease.
  • The muscles and bones should be palpated carefully.
physical examination2
Physical Examination
  • Examine for Lymphadenopathy

Cervical Area 1. Lymphoma

(Localized) 2. Tuberculosis

3. Infectious Mononucleosis

4. Lymphadenitis (bacterial)

diagnostic testing
Diagnostic Testing
  • CBC with a differential WBC count and a urinalysis should be part of the initial laboratory evaluation.
  • An erythrocyte sedimentation rate (ESR).
  • C-reactive protein is another acute-phase reactant that becomes elevated and returns to normal more rapidly than the ESR.
diagnostic testing1
Diagnostic Testing
  • serology
    • Anti-nuclear Antibodies
    • Rheumatoid Factor
    • CMV Antibody … IgM
    • Heterophile Antibody Test in children and young adult
    • Tuberculin Skin Test … 5 unit ID
    • Thyroid Function Test
    • HIV Screening
diagnostic testing2
Diagnostic Testing
  • Cultures
    • Blood
      • Obtain more than 3 blood cultures from separate venipunctures over 24 hr period if you are suspecting inf. Endocarditis prior antimicrobial use.
      • Incubate the blood for 4 weeks, to detect the presence of SBE & Brucellosis
    • Sputum: For Tuberculosis
    • Any normal sterile:
      • CSF/urine/pleural or peritoneal fluid
      • Bone marrow aspirate → Tuberculosis/Brucellosis
      • Lymph node Bx → TB
diagnostic testing3
Diagnostic Testing
  • Imaging Studies: … to localize abnormalities for definite tests or treatment
    • Chest x-ray:
      • Atelectasis } 1. Liver

↑ Hemi diaphragm } Abscess 2. Spleen

Pleural Effusion } 3. Pancreatic

4. Subphrenic

      • Mediastinal mass → Lymphoma/Tuberculosis/ Sarcoid
      • If CXR is (N) → Repeat on weekly basis
diagnostic testing4
Diagnostic Testing
  • CT-Scan → CT scan chest
    • Mediastinal mass → Tuberculosis/Lymphoma/ Sarcoidosis
    • CT-Scan Abdomen → very effective to visualize
      • All types of abscesses
      • Retroperitoneal tumor, lymph node or haematoma
  • MRI: spleen, lymph node and the brain
  • Radionuclide scans
slide27
The majority of disease remaining after an

initial NEGATIVE work-up are:

  • Neoplasm
  • Seronegative Collagen Vascular Disease
  • Increasing Tuberculosis
  • Increasing Drug Addition
  • Endocarditis
  • HIV with or without infection or malignancy
  • Implanted prosthetic devices
  • Travel … New Exposure
therapeutic trials
Therapeutic Trials
  • Limitation and risk of empirical therapeutic trials:
    • Rarely specific
    • Underlying disease may remit spontaneously false impression of success.
    • Disease may respond partially and this may lead to delay in specific diagnosis.
    • Side effect of the drugs can be misleading.
therapeutic trials1
Therapeutic Trials
  • To hold therapeutic trials in the early stage… except in:
    • Patient who is very sick to wait.
    • All tests have failed to uncover the etiology.
    • Tuberculosis
    • Culture-negative endocarditis.