– this is a condition characterized by an increase in body temperature over 38 degrees for 3 weeks, and at the same time, routine research methods do not reveal the causes of its occurrence. In about 35% of cases, prolonged fever of unknown origin is caused by infections, 20% – oncological diseases, 15% – collagenosis.
In 15% of cases, the etiological cause of prolonged fever of unknown origin remains unknown. For more information about what diseases can occur under the guise of a prolonged fever of unknown origin, as well as about the correct diagnostic tactics of a doctor, read on estet-portal.com in this article.
How to avoid unreasonable tests for fever of unknown origin
Despite the fact that in our time there is a clear diagnostic algorithm for fever of unknown origin, many doctors prescribe "feverish" many expensive and unreasonable tests for patients.
According to the EMB Guidelines «Prolonged fever in the adult», patients with prolonged fever of unknown cause should first be ruled out by appropriate investigations of the following:
1.
Pneumonia(Chest x-ray and auscultation). Chest x-rays are also useful in diagnosing tuberculosis, sarcoidosis, alveolitis, or lung masses as possible causes of persistent fever; 2.
Urinary tract infection(general urinalysis and bacteriological examination of urine). Urinalysis may also be helpful in diagnosing epidemic nephropathy, nephritis, or renal neoplasms as possible causes of persistent fever; 3.
Maxillary sinusitis(ultrasound or X-ray examination of the maxillary sinus). Follow our news on
Instagram Modern diagnostic algorithm for fever of unknown origin
When taking a history of illness in a patient with prolonged fever, the clinician should be aware of important questions that must be asked of the patient.
These include:1. Country and living conditions, as well as recent travel of the patient;
2. History of tuberculosis and valvular heart disease in the patient;
3. The nature of sexual life, the presence of unprotected sexual intercourse;
4. Injecting drug use;
5. Dental interventions in previous months;
6. Rheumatic diseases in close relatives;
Thus, according to the EMB Guidelines "Prolonged fever in the adult", a patient with a prolonged fever of unknown origin should first of all undergo the following tests:
1. General urinalysis and bacteriological examination of urine;
2. Complete blood count with leukocyte formula and SHOE;
3. Determining the level of CRP;4. Determining the level of ALT, AST;
5. HIV test (after informed consent of the patient);
6.
7. EKG;
8. OGP X-ray;
9. X-ray or ultrasound of the maxillary sinus.
The above research methods are primary for patients with prolonged fever of unknown origin and allow to identify the etiological cause of the disease in most cases.
But in some cases, all primary research methods may also be uninformative, which is an indication for secondary diagnostic tests.
Fever of unknown cause: secondary diagnostic tests
Secondary diagnostic tests are aimed at finding the cause of fever of unknown origin when primary tests have not provided any useful diagnostic information.Secondary diagnostic tests include:
1. Serological tests (according to the history of the disease and the symptoms present): diagnosis of yersiniosis, tularemia, Lyme disease, viral hepatitis, mononucleosis, Cornell fever;
2. Determining the level of thyroid hormones;
3. Blood culture;
4. Stool culture;
5. Ultrasound of the OBP and small pelvis.
Quite often, the cause of prolonged fever of unknown origin is abscesses of the abdominal cavity and pelvis, to which the patient may be predisposed by previous abdominal, gynecological operations, trauma, diverticulosis and peritonitis.
In such cases, a blood culture, ultrasound of the OBP and small pelvis have a diagnostic value. Sometimes a whole-body scintigraphy with autologous leukocytes labeled with technetium - Tc99m or indium - In111 is required to confirm the diagnosis.
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Fever of unknown origin: most common etiological causes
Thus, there are many causes of unexplained fever, but the most common include infection, collagenosis, and cancer.Finally, we would like to highlight a list of diseases that are most often disguised as a diagnosis of "fever of unknown origin". These include:
1. Tuberculosis (pulmonary and extrapulmonary forms);
2. Infections:
a. Sinusitis;
b. Urinary tract infection;
c. Intra-abdominal infections (cholecystitis, appendicitis, abscesses);
d. Perianal abscess;
e. Abscesses of the chest cavity (lungs, mediastinum);
f. Bronchiectasis;
g. Salmonellosis, shigellosis;
h. Osteomyelitis;
i. Mononucleosis;
j. Adenoviral infection, cytomegalovirus infection, or Coxsackie B virus infection;
k. Hepatitis;
l. HIV;
m. Chlamydial infection (psittacosis, ornithosis);
o. Lyme Disease;
p. Tularemia;
q. Malaria;
3. Endocarditis;
4. Infections associated with foreign objects implanted in the body (endoprostheses);
5. Sarcoidosis;
6. Atrial myxoma;
7. Subacute thyroiditis and hyperthyroidism;
8. Hematological diseases;
9. Vascular thrombosis, pulmonary embolism
10. Erythema nodosum;
11. Drug fever caused by drugs such as Allopurinol, Captopril, Cimetidine, Clofibrate, Erythromycin, Heparin, Hydralazine, Hydrochlorothiazide;
12. Malignant neuroleptic syndrome, serotonin syndrome;
13. Allergic alveolitis;
14. Ankylosing spondylitis;
15. Rheumatoid arthritis;
16. Systemic lupus erythematosus (SLE);
17. Rheumatic fever;
18. Nodular periarteritis;
19. Wegener's granulomatosis;
20. Inflammatory bowel disease: Crohn's disease, ulcerative colitis;
21. cirrhosis of the liver, alcoholic hepatitis;
22. Oncological diseases: leukemia, pancreatic and bile duct cancer, kidney cancer (hypernephroma), sarcoma, lymphoma.
A correct, stepwise diagnostic approach to identifying the cause of a fever of unknown origin helps the doctor find the cause of the condition in most cases.
Thank you for staying with estet-portal.com. Read other interesting articles in the "Infectology" section. You may also be interested in Dengue fever has a favorable outcome, but a severe course
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