Fever of Unknown Origin History

• CC:
  • Documentation of the fever: route of measurement? Readings? Frequency?
  • Onset: when? Frist time? Sudden\gradual? Intermittent\continuous? Getting better\worse?
  • Time: specific time of day? More at night?
  • Aggravating\relieving factors: antipyretics?
  • Severity: affecting ADL?

• Associated sx:
  • Constitutional: fever, wt loss, loss of appetite, night sweats, chills?
  • CNS: headache, photophobia, stiff neck, confusion?
  • Resp: chest pain, cough\sputum, hemoptysis, ENT Sx?
  • GI: N\V, diarrhea, abdominal pain, jaundice?
  • GU: dysuria, hematuria, vaginal discharge?
  • Rhemua: joint pain, muscle aches, rash?

• PMHx:
  • Diseases:
    • Chronic ds (HTN, DM, DLP)
    • Infections (HIV)
    • Autoimmune ds
    • Malignancy
  • Medications: steroids, abx, chemo
  • Surgery (transplant, dental, urine cath), hospitalization, trauma
  • Blood transfusions, IV drug use, tattoos
  • Allergies

• FMHx:
  • Similar complaint?
  • Same diseases as in PMHx?

• Social Hx:
  • Occupation, marital status, children?
  • Smoking, alcohol, recreational drugs?
  • Travel Hx, contact with sick pts\animals?
    • Where? Duration?
    • Activities: accommodation? Hiking? Diet? Sexual contact?
    • Vaccinations? Anti-malarial prophylaxis?
  • Diet (raw milk), exercise

• Definition of Fever of Unknown Origin (FUO)?
  • Classic FUO:
    • ≥ 38.3° C
    • ≥ 3 weeks
    • Measure in 3 outpatient visits or 3 inpatient days

• DDx of FUO?
  • Infections: TB, CMV, EBV
  • Malignancy: lymphoma, leukemia, RCC
  • Vasculitis\connective tissue ds: still’s ds
  • Drug fever
  • Factitious fever

• Definition of SIRS?
  • Two or more of:
    • Fever or hypothermia
    • Hyperventilation or PaO₂ < 32
    • Tachycardia
    • High WBC (> 12,000)

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