Chapter 019. Fever of Unknown Origin (Part 1)

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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...

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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 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
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, increasingly useful diagnostic technologies—both noninvasive and invasive—have been developed. Newer studies reflect not only changing patterns of disease but also the impact of diagnostic techniques that make it possible to eliminate many patients with specific illness from the FUO category. The ubiquitous use of potent broad- spectrum antibiotics may have decreased the number of infections causing FUO. The wide availability of ultrasonography, CT, MRI, radionuclide scanning, and positron emission tomography (PET) scanning has enhanced the detection of localized infections and of occult neoplasms and lymphomas in patients previously thought to have FUO. Likewise, the widespread availability of highly specific and sensitive immunologic testing has reduced the number of undetected cases of systemic lupus erythematosus and other autoimmune diseases. Table 19-1 Classic FUO in Adults A Y In Ne Noni Misc Und uthors ears of o. of fections oplasms nfectious ellaneous iagnosed (Year of Study Cases (%) (%) Inflammat Causes (%) Causes Publicati ory (%) Diseases
on) (%) Pe 1 36 19 19a 19a 7 tersdorf 952– 00 and 1957 Beeson (1961) La 1 30 31 16a 11a 12 rson and 970– 05 Featherst 1980 one (1982) K 1 22 7 23a 21.5a 25.5 nockaert 980– 99 .5 and 1989 Vanneste (1992) de 1 26 12. 24 8 30
Kleijn et 992– 67 5 al. (1997, 1994 Part I) a Authors' raw data retabulated to conform to altered diagnostic categories. Source: Modified from de Kleijn et al., 1997 (Part I).