Pyrexia of Unknown Origin (PUO)

1. Pyrexia of Unknown Origin (PUO) Definition: In adults: T>38.3 for>3 weeks with no known origin despite appropriate Ix. • Approach: - identify cause • Detailed history and regular examination • Confirm temperature objectively, ?admission, ?physiological with circadian pattern • Guide investigation based on initial test results • Blind investigation may be necessary • FBE, ESR, U+E, CRP, LFT, ANA, RhFx, TFT • Regular cultures (any fluid – blood, sputum, urine, stool, CSF) • CXR, CTA, echo • CT, IVP, MRI, PET • Treatment – ideally symptomatic prior to Dx • Empirical A/B therapy may mask infectious Dx • Empirical steroid therapy may mask inflammatory response w/o treating cause • Undiagnosable PUO – Sx usually spontaneously resolve, good prognosis

2. Patterns of fever Typical malarial fever patterns - not necessarily useful diagnostically • Day 1 – onset of disease – T? • Day 4 – visit doctor – 36.2 • Day 5 – 10am – 36.9 • Day 5 – afternoon – 36.9 • Day 5 – night – 38.5 • *NO FEVER RECORDED* • Doesnt always follow typical pattern in all patients • Accurate recording procedure

3. Special points for an ID Ex- Note: get image from Amanda to put on this slide • Gen Inspection • Room • Sputum cup • O2 • IV – anything running • Drain tube • Catheter – check urine • Temp chart • Patient • Distress (RR, diaphoretic, conscious state) • Rash – blanching/non- • Track marks IVDU • Any lines – sepsis? • Weight loss – chronic illness • Hands • Janeway • Splinters • Osler’s nodes • Erythema • Track marks • Bruising, petechiae • Phlebitis • Arthropathy, raynauds - CTD • Face • Eyes – Roth spots (fundoscopy), pallor, jaundice (BW fever) • Mouth – hygeine, ginigivitis, abscess • Neck – lymphadenopathy • Chest • Crepitations, consolidation • Praecordium • New murmur • Abdomen • Tenderness? – localised? • Organomegaly • rashes • Genitourinary • Stool sample • Urinalysis • Discharge • orchitis • Legs • Rash • ulcers