Pyrexia of unknown origin
Last updated: Friday, 28, January, 2011
| Causes | Appropriate Tests |
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PUO is defined as undiagnosed fever of more than 3 weeks duration. |
Careful and repeated clinical history and examination; FBC, blood film, differential WCC; CRP ; bilirubin, ALP, AST, ALT, GGT, LD. |
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Bacterial infection, especially |
Blood culture (repeated); urine microscopy and culture; faeces - microscopy, culture and antigen detection. |
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Abscess, especially
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Ascending cholangitis |
See Cholestasis |
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Typhoid fever |
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| Urine for mycobacteria testing; collect early morning specimens (three). | |
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Fungal infection |
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| Cryptococcal antigen - blood, CSF, if appropriate. | |
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Protozoal infection |
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| Malaria parasites - blood - repeated thin and thick blood films, if indicated. | |
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Viral infection |
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Drug fever |
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Malignancy, especially |
FNAB, lesion biopsy; as appropriate. Tumour markers are unreliable as a screening test for occult malignancy. |
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Renal cell carcinoma |
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Hepatocellular carcinoma |
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Disseminated carcinoma |
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Atrial myxoma |
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Other |
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Granulomatous hepatitis |
See Hepatitis - Granulomatous |
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Familial Mediterranean fever |
Clinical diagnosis. CRP (intermittent elevation); biopsy of appropriate tissue only if clinical features suggest amyloidosis. |
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Occult haematoma, especially
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Factitious fever |