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...
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Chapter 019. Fever of Unknown Origin (Part 3) Chapter 019. Fever of Unknown Origin (Part 3) Source: From a study of 347 patients referred to the National Institutes ofHealth from 1961 to 1977 with a presumptive diagnosis of FUO of >6 monthsduration (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 ofclassic FUO in adults; the most common of these are listed in Table 19-3. This listapplies strictly to the United States. Geographic considerations are paramount. Forexample, in Japan, human T cell lymphotropic virus type I is a consideration; inChina, infection plays a greater role and tuberculosis is prominent; and in Spain,visceral leishmaniasis may be a more common cause of FUO. The frequency ofglobal travel underscores the need for a detailed travel history, and the continuingemergence of new infectious diseases makes this listing potentially incomplete.The possibility of international and domestic terrorist activity involving theintentional release of infectious agents, many of which cause illnesses presentingwith prolonged fever, underscores the need for obtaining an insightfulenvironmental, occupational, and professional history, with early notification ofpublic 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 abscessIntravascular infections Bacterial aortitis Bacterial endocarditis Vascular catheter infectionSystemic 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 TularemiaTyphoid fever Vibriosis Yersinia infectionMycobacterial infections M. avium/M. intracellulare infections Other atypical mycobacterial infections TuberculosisOther bacterial infections Actinomycosis Bacillary angiomatosis Nocardiosis Whipples diseaseRickettsial infections Anaplasmosis Ehrlichiosis Murine typhus Q fever Rickettsialpox Rocky Mountain spotted feverMycoplasmal infectionsChlamydial infections Lymphogranuloma venereum Psittacosis TWAR (C. pneumoniae) infectionViral 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 infectionFungal infections Aspergillosis Blastomycosis Candidiasis Coccidioidomycosis Cryptococcosis Histoplasmosis Mucormycosis Paracoccidioidomycosis Pneumocystis infection SporotrichosisParasitic infections Amebiasis Babesiosis Chagas disease Leishmaniasis Malaria Strongyloidiasis Toxocariasis Toxoplasmosis TrichinosisPresumed infections, agent undetermined Kawasakis disease (mucocutaneous lymph node syndrome) Kikuchis necrotizing lymphadenitisNeoplasmsMalignant Colon cancer Gall bladder carcinoma Hepatoma Hodgkins lymphoma Immunoblastic T-cell lymphoma Leukemia Lymphomatoid granulomatosis Malignant histiocytosis Non-Hodgkins lymphoma Pancreatic cancer Renal cell carcinoma SarcomaBenign Atrial myxoma Castlemans disease Renal angiomyolipomaHabitual Hyperthermia(Exaggerated circadian rhythm)Collagen Vascular/Hypersensitivity DiseasesAdult Stills diseaseBehçets diseaseErythema multiformeErythema nodosumGiant-cell arteritis/polymyalgia rheumaticaHypersensitivity pneumonitisHypersensitivity vasculitisMixed connective-tissue diseasePolyarteritis nodosaRelapsing polychondritisRheumatic feverRheumatoid arthritisSchnitzlers syndromeSystemic lupus erythematosusTakayasus aortitisWeber-Christian diseaseWegeners granulomatosisGranulomatous DiseasesCrohns diseaseGranulomatous hepatitisMidline granulomaSarcoidosisMiscellaneous ConditionsAortic dissectionDrug feverGoutHematoma ...