• Fever of Unknown Origin

    (FUO; Pyrexia of Unknown Origin)

    Definition

    A high temperature without a clear cause is called fever of unknown origin (FUO). A FUO is an intermittent temperature of at least 101°F. It has to have been noted for over three weeks. It also has to have at least a week’s worth of attempts to find the cause.

    Causes

    There are many rare causes of a high temperature. The following list includes just a few of the uncommon causes:
      Unusual infections, such as:
      • Extrapulmonary (located elsewhere than in the lungs) tuberculosis
      • Atypical tuberculosis (relatives of the common germ)
      • Tropical diseases in temperate climates/latitudes (eg, malaria , dengue fever , yellow fever )
      • Rare organisms—fungi, viruses, uncommon bacteria
    • Obscure infections (eg, prostatitis , sinusitis , hidden abscesses)
    • Collagen vascular (connective tissue, autoimmune) diseases (eg, rheumatoid arthritis , lupus )
    Rheumatoid Arthritis
    Rheumatoid Arthritis
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    Risk Factors

    The following factors increase your chance of developing a FUO:
    • Foreign travel, especially to developing and tropical countries
    • Current medicines (both prescription and over-the-counter)
    • Cancer or brain tumor
    • Collagen vascular disease (an autoimmune disorder of connective tissue)
    • HIV/AIDS
    • Current or recent hospitalization
    • Similar problems in your family

    Symptoms

    If you experience any of these, do not assume it is due to a FUO. A fever is a very common indication of many problems. They can be both serious and trivial. If you experience any one of them, see your doctor.
    • Elevated temperature by thermometer reading
    • Sweats
    • Chills
    • Aching all over

    Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. You can help by taking your temperature several times a day. Your doctor may refer you to a specialist.
    The first efforts after the evaluation will be to narrow the possibilities. This is done by examining the circumstances under which the fever began. Were you traveling abroad? Were you hospitalized? Is your immune system damaged? What medicines are you currently taking?
    Many different tests may be indicated at some point including:
    • Exhaustive studies of blood, urine, and all other bodily products
    • Exhaustive imaging studies: x-rays , CT and MRI scans, ultrasound examinations
    • Nuclear medicine studies
    • Endoscopies of the lungs, stomach and intestines , sinuses
    • Tissue biopsies
    Endoscopy
    Endoscope in stomach
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    Treatment

    There is no treatment for a FUO until the underlying disease is identified. When its cause is discovered, treatment will follow.

    Prevention

    There are so many causes for a FUO. But, you can take steps to stay healthy. This is very important when you travel abroad. Take all of the preventative measures recommended by the public health department.

    RESOURCES

    International Travel and HealthWorld Health Organization http://www.who.int/ith/en/

    Traveler's HealthCenter for Disease Control http://wwwnc.cdc.gov/travel/

    CANADIAN RESOURCES

    Center for Disease Control http://www.cdc.gov/

    Health Canada http://www.hc-sc.gc.ca/

    References

    Amin K, Kauffman CA. Fever of unknown origin: a strategic approach to this diagnostic dilemma. Postgraduate Medicine Online website. Available at: http://www.postgradmed.com/issues/2003/09%5F03/amin.htm . Accessed September 14, 2005.

    Beers MH, Berkow R. Biology of infectious disease. In: The Merck Manual . 17th ed. West Point, PA: Merck; 1999.

    Behrman RE, et al. Nelson’s Textbook of Pediatrics. 18th ed. Philadelphia, PA: Saunders; 2007.

    Gelfand JA, Callahan MV. Fever of unknown origin. In: Kasper DL, Braunwald E, Fauci A, Hauser S, Longo D, Jameson JL. Harrison's Principles of Internal Medicine . 16th ed. New York: McGraw-Hill; 2005: 16-121.

    Goldman L, Ausiello D, eds. Cecil Textbook of Internal Medicine. 23rd ed. Philadelphia, PA: Saunders; 2008.

    Roth AR, Basello GM. Approach to the adult patient with fever of unknown origin. American Family Physician website. Available at: http://www.aafp.org/afp/20031201/2223.html . Accessed September 14, 2005.

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