TAILIEUCHUNG - Chapter 019. Fever of Unknown Origin

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 ≥°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. . | Chapter 019. Fever of Unknown Origin 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 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 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 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 compilation of data regarding these disparate groups. In the remainder of this chapter the discussion will focus on classic FUO in the adult unless otherwise specified. Causes of Classic FUO Table 19-1 summarizes the findings of several large studies of FUO carried out since the advent of the antibiotic era including a prospective study of 167 adult patients with FUO encompassing all eight university hospitals in the Netherlands and using a standardized protocol in which the first author reviewed every patient. Coincident with the widespread use of antibiotics .

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