FEVER OF UNKNOWN ORIGIN: DIAGNOSTIC ALGORITHM AND PATIENT MANAGEMENT TACTICS
DOI:
https://doi.org/10.11603/1681-2727.2023.1.13925Keywords:
fever of unknown origin, algorithm, tacticsAbstract
SUMMARY. The article highlights the current definition, classification, and main causes of febrile illness of unknown origin (FUO). The algorithm of diagnostic search consists of a thorough clinical and anamnestic examination, routine laboratory and instrumental investigations, which are the basis for the initial assessment of a patient with prolonged unspecified fever, as well as the appointment of the latest diagnostic methods: laboratory special tests to exclude infectious and autoimmune diseases, non-invasive and invasive instrumental tests for the diagnosis of oncohematological and other pathologies. Approaches to the prescription of empirical therapy for patients with FUO are considered. Successful solution to the problem of differential diagnosis of this condition depends on the constructive interaction of many specialists (family doctors, infectious disease specialists, rheumatologists, hematologists, oncologists, surgeons), their awareness of diseases that presents with prolonged unspecified fever, and understanding of the tactics of patient management.
References
Brown, I., & Finnigan, N. A. (2022). Fever of Unknown Origin. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK532265/
Cunha, B. A., Lortholary, O., & Cunha, C. B. (2015). Fever of unknown origin: A clinical approach. The American Journal of Medicine, 128 (10), 1138–e1. DOI: https://doi.org/10.1016/j.amjmed.2015.06.001
Perederii, V., & Tkach, S. (2010). Basics of internal medicine. Nova Knyha [in Ukrainian].
Kopcha, V. S., Leheza, K. M., Shpikula, N. H., Ivanchyshyn, M. V., Sukhina, N. V., & Kopcha, Yu. V. (2011). Prolonged subfebrile fever and fever of unknown origin. Infektsiini khvoroby – Infectious Diseases, (3). https://ojs.tdmu.edu.ua/index.php/inf-patol/article/view/602 [in Ukrainian].
Haidar, G., & Singh, N. (2022). Fever of Unknown Origin. New England Journal of Medicine, 386 (5), 463–477. https://doi.org/10.1056/NEJMra2111003 DOI: https://doi.org/10.1056/NEJMra2111003
Pannu, A. K., Golla, R., Kumari, S., Suri, V., Gupta, P., & Kumar, R. (2021). Aetiology of pyrexia of unknown origin in north India. Tropical Doctor, 51 (1), 34–40. DOI: https://doi.org/10.1177/0049475520947907
Yenilmez, E., Kakalicoglu, D., Bozkurt, F., Filiz, M., Akkol Camurcu, A., Damar Midik, E. O., Berk Cam, H., Arkali, E., Bilgic Atli, S., & Sahin, A. (2021). Fever of unknown origin (FUO) on a land on cross‐roads between Asia and Europa; a multicentre study from Turkey. International Journal of Clinical Practice, 75 (6), e14138. DOI: https://doi.org/10.1111/ijcp.14138
Kubota, K., Tanaka, N., Miyata, Y., Ohtsu, H., Nakahara, T., Sakamoto, S., Kudo, T., Nishiyama, Y., Tateishi, U., & Murakami, K. (2021). Comparison of 18 F-FDG PET/CT and 67 Ga-SPECT for the diagnosis of fever of unknown origin: A multicenter prospective study in Japan. Annals of Nuclear Medicine, 35, 31–46. DOI: https://doi.org/10.1007/s12149-020-01533-z
Spernovasilis, N., Tsioutis, C., Markaki, L., Zafeiri, M., Soundoulounaki, S., & Gikas, A. (2020). Fever of unknown origin caused by infectious diseases in the era of migrant and refugee crisis. Travel Medicine and Infectious Disease, 33, 101425. DOI: https://doi.org/10.1016/j.tmaid.2019.05.011
Kim, Y.-S., Kim, K.-R., Kang, J.-M., Kim, J.-M., & Kim, Y.-J. (2017). Etiology and clinical characteristics of fever of unknown origin in children: A 15-year experience in a single center. Korean Journal of Pediatrics, 60 (3), 77. DOI: https://doi.org/10.3345/kjp.2017.60.3.77
Fusco, F. M., Pisapia, R., Nardiello, S., Cicala, S. D., Gaeta, G. B., & Brancaccio, G. (2019). Fever of unknown origin (FUO): Which are the factors influencing the final diagnosis? A 2005–2015 systematic review. BMC Infectious Diseases, 19, 1–11. DOI: https://doi.org/10.1186/s12879-019-4285-8
Mulders-Manders, C., Simon, A., & Bleeker-Rovers, C. (2015). Fever of unknown origin. Clinical Medicine (London, England), 15 (3), 280–284. https://doi.org/10.7861/clinmedicine.15-3-280 DOI: https://doi.org/10.7861/clinmedicine.15-3-280
Holubovska, O. A., Andreychyn, M. A., Shkurba, A. V., Bodnia, K. I., Vasylieva, N. A., Herasun, B. A., … Sukach, M. M. (2022). Infectious diseases: a textbook for students of higher medical education institutions. Medicine [in Ukrainian].
Petersdorf, R. G., & Beeson, P. B. (1961). Fever of unexplained origin: Report on 100 cases. Medicine, 40, 1–30. https://doi.org/10.1097/00005792-196102000-00001 DOI: https://doi.org/10.1097/00005792-196102000-00001
Durack, D. T., & Street, A. C. (1991). Fever of unknown origin—Reexamined and redefined. Current Clinical Topics in Infectious Diseases, 11, 35–51.
Wright, W. F., Mulders-Manders, C. M., Auwaerter, P. G., & Bleeker-Rovers, C. P. (2022). Fever of unknown origin (FUO)–a call for new research standards and updated clinical management. The American Journal of Medicine, 135(2), 173–178. DOI: https://doi.org/10.1016/j.amjmed.2021.07.038
Wright, W. F., & Auwaerter, P. G. (2020). Fever and Fever of Unknown Origin: Review, Recent Advances, and Lingering Dogma. Open Forum Infectious Diseases, 7(5), ofaa132. https://doi.org/10.1093/ofid/ofaa13221 DOI: https://doi.org/10.1093/ofid/ofaa132
Dubynska, H. M., Iziumska, O. M., Koval, T. I., Poltorapavlov, V. A., Bodnar V. A., & Marchenko, O. H. (2016). General principles of examination of patients, algorithms of practical skills and emergency care in critical conditions in the clinic of infectious diseases - a textbook for interns and students of higher education institutions of III-IV accreditation levels: (Part I). Magnolia 2006 [in Ukrainian].
Bodnar, V. A., Kotelevska, T. M., & Ponimatchenko, S. L. (2022). Acute kidney damage as a complication of malaria caused by Pl. malaria and Pl. falciparum: clinical cases. Wiadomosci lekarskie, 75(8 pt 2), 2041–2044 [in Ukrainian]. DOI: https://doi.org/10.36740/WLek202208218
Kotelevska, T. M., Pryimenko, N. O., Dubynska, H. M., Koval, T. I., Iziumska, O. M., & Zviagolska, I. M. (2020). West Nile Fever in the central part of Ukraine. Medychni perspektyvy – Medical perspectives, 25 (3), 204–210 [in Ukrainian]. DOI: https://doi.org/10.26641/2307-0404.2020.3.214874
Svintsitskyi, A. S., Haievski, P. (2018). Internal diseases. A textbook based on the principles of evidence-based medicine 2018/19. Praktychna Medytsyna – Practical Medicine [in Ukrainian].
Schönau, V., Vogel, K., Englbrecht, M., Wacker, J., Schmidt, D., Manger, B., Kuwert, T., & Schett, G. (2018). The value of 18F-FDG-PET/CT in identifying the cause of fever of unknown origin (FUO) and inflammation of unknown origin (IUO): Data from a prospective study. Annals of the Rheumatic Diseases, 77(1), 70–77. https://doi.org/10.1136/annrheumdis-2017-211687 DOI: https://doi.org/10.1136/annrheumdis-2017-211687
Kouijzer, I. J. E., Mulders-Manders, C. M., Bleeker-Rovers, C. P., & Oyen, W. J. G. (2018). Fever of Unknown Origin: The Value of FDG-PET/CT. Seminars in Nuclear Medicine, 48 (2), 100–107. https://doi.org/10.1053/j.semnuclmed.2017.11.004 DOI: https://doi.org/10.1053/j.semnuclmed.2017.11.004
Bleeker-Rovers, C. P., Vos, F. J., de Kleijn, E. M. H. A., Mudde, A. H., Dofferhoff, T. S. M., Richter, C., Smilde, T. J., Krabbe, P. F. M., Oyen, W. J. G., & van der Meer, J. W. M. (2007). A prospective multicenter study on fever of unknown origin: The yield of a structured diagnostic protocol. Medicine, 86 (1), 26–38. https://doi.org/10.1097/MD.0b013e31802fe858 DOI: https://doi.org/10.1097/MD.0b013e31802fe858
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