know How Do You Treat Pyrexia?

know How Do You Treat Pyrexia ?

 Pyrexia of unknown origin :

A 63 yer old man with a recent history of TURP was admitted with fever of 15 days duration . A thorough clinical examination revealed no localising signs. All basic investigation including viral makers, HIV and a bone marrow aspiration were normal. He had significant weight loss of 9kg , as the fever persisted for 3 months without diagnosis. CT abdomen and Endoscopy were also performed. Except for a huge diverticulum in the colon there was nothing else significant.

know How Do You Treat Pyrexia ?

Old Defination

  1. Fever higher than 38.3 degree celsius  on several occasions.
  2. Duration of fever -3 week
  3. Uncertain diagnosis after one week of study in hospital

Classification:

know How Do You Treat Pyrexia ?

  • Classical PUO
  • Nosocomial PUO
  • Neutropenic PUO
  • HIV PUO
  • Transplant PUO

PUO – CAUSES

  • Infection – 30%
  • Malignancy – 20%
  • Connective tissue disorder – 15%
  • Miscelleneous – 20%

Occurrences

  • Adults : 25 – 40% infections ,  25 – 40% cancers
  • Children : 30 – 50% infections ,  5 – 10% cancers
  • Autoimmune disorders 10 – 20% in both adults and children

Fevers Lasting More Than 6 Months

  • Extrapulmonary TB
  • Disseminated Tuberculosis and Histoplasmosis
  • Lymphomas
  • Certain Autoimmune disorders
  • Facitious
  • Hypothalamic (Rare)
  • Mononucleosis syndromes
  • Intra abdominal abcesses
  • Very indolent fevers like brucellosis
  • Location of infection

History Taking

  • Travel – (Exotic travels – visits to caves , trecking )
  • Nutritional history especially diary products
  • Drug abuse, IV drugs
  • Sexual history
  • Blood transfusion
  • Ear discharge

Clinical Examination

  • Alooecia
  • Sinuses
  • Ears
  • Gum bleeds
  • Throid
  • Nail chnges
  • Skin changes
  • Sternal tenderness

Investigation

  • Basic investigation
  • Specimens examined – urine , blood , sputum
  • CT SCAN , MRI
  • Doppler studies
  • ECG, X- Ray chest

The clue from the above may help to choose the special investigation .

Hit Or Miss

  • If we follow the order of HISTORY , its INFERENCE, , followed by appropriate TESTS, we are likely to HIT the right diagnosis

BUT

If we start with the MANAGEMENT , then INVESTIGATE and fail to look at the SYMPTOMS and SIGNS , we might MISS the right diagnosis

Invasive Procedures :

  • Endoscopy of GIT
  • Bone marrow aspiration
  • Exploratory laparotomy

Conclusion

From comprehensive and meticulous history taking upto appraisal of the patient, the fever of unknown origin first described by Petersdorf way back in 1961, still makes the physician stand on his toes. More than half a century of technological advance has facilitated the discovery of more complicate analysis of the disease process rather than its relief.

 

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