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Chapter 019. Fever of Unknown Origin (Part 4)

Specialized Diagnostic Studies Classic FUO A stepwise flow chart depicting the diagnostic workup and therapeutic management of FUO is provided in Fig. 19-1. In this flow chart, reference is made to "potentially diagnostic clues," as outlined by de Kleijn and colleagues; these clues may be key findings in the history (e.g., travel), localizing signs, or key symptoms. Certain specific diagnostic maneuvers become critical in dealing with prolonged fevers. If factitious fever is suspected, electronic thermometers should be used, temperature-taking should be supervised, and simultaneous urine and body temperatures should be measured. Thick blood smears should be examined for Plasmodium; thin. | Chapter 019. Fever of Unknown Origin Part 4 Specialized Diagnostic Studies Classic FUO A stepwise flow chart depicting the diagnostic workup and therapeutic management of FUO is provided in Fig. 19-1. In this flow chart reference is made to potentially diagnostic clues as outlined by de Kleijn and colleagues these clues may be key findings in the history e.g. travel localizing signs or key symptoms. Certain specific diagnostic maneuvers become critical in dealing with prolonged fevers. If factitious fever is suspected electronic thermometers should be used temperature-taking should be supervised and simultaneous urine and body temperatures should be measured. Thick blood smears should be examined for Plasmodium thin blood smears prepared with proper technique and quality stains and subjected to expert microscopy should be used to speciate Plasmodium and to identify Babesia Trypanosoma Leishmania Rickettsia and Borrelia. Any tissue removed during prior relevant surgery should be reexamined slides should be requested and if need be paraffin blocks of fixed pathologic material should be reexamined and additional special studies performed. Relevant x-rays should be reexamined reviewing of prior radiologic reports may be insufficient. Serum should be set aside in the laboratory as soon as possible and retained for future examination for rising antibody titers. Figure .