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Chapter 019. Fever of Unknown Origin (Part 1)

Harrison's Internal Medicine Chapter 19. Fever of Unknown Origin Definition and Classification Fever of unknown origin (FUO) was defined by Petersdorf and Beeson in 1961 as (1) temperatures of 38.3°C (101°F) on several occasions; (2) a duration of fever of 3 weeks; and (3) failure to reach a diagnosis despite 1 week of inpatient investigation. While this classification has stood for more than 30 years, Durack and Street have proposed a new system for classification of FUO: (1) classic FUO; (2) nosocomial FUO; (3) neutropenic FUO; and (4) FUO associated with HIV infection. Classic FUO corresponds closely to the earlier. | Chapter 019. Fever of Unknown Origin Part 1 Harrison s Internal Medicine Chapter 19. Fever of Unknown Origin Definition and Classification Fever of unknown origin FUO was defined by Petersdorf and Beeson in 1961 as 1 temperatures of 38.3 C 101 F on several occasions 2 a duration of fever of 3 weeks and 3 failure to reach a diagnosis despite 1 week of inpatient investigation. While this classification has stood for more than 30 years Durack and Street have proposed a new system for classification of FUO 1 classic FUO 2 nosocomial FUO 3 neutropenic FUO and 4 FUO associated with HIV infection. Classic FUO corresponds closely to the earlier definition of FUO differing only with regard to the prior requirement for 1 week s study in the hospital. The newer definition is broader stipulating three outpatient visits or 3 days in the hospital without elucidation of a cause or 1 week of intelligent and invasive ambulatory investigation. In nosocomial FUO a temperature of 38.3 C 101 F develops on several occasions in a hospitalized patient who is receiving acute care and in whom infection was not manifest or incubating on admission. Three days of investigation including at least 2 days incubation of cultures is the minimum requirement for this diagnosis. Neutropenic FUO is defined as a temperature of 38.3 C 101 F on several occasions in a patient whose neutrophil count is 500 pL or is expected to fall to that level in 1-2 days. The diagnosis of neutropenic FUO is invoked if a specific cause is not identified after 3 days of investigation including at least 2 days incubation of cultures. HIV-associated FUO is defined by a temperature of 38.3 C 101 F on several occasions over a period of 4 weeks for outpatients or 3 days for hospitalized patients with HIV infection. This diagnosis is invoked if appropriate investigation over 3 days including 2 days incubation of cultures reveals no source. Adoption of these categories of FUO in the literature has allowed a more rational .