Pyrexia of unknown origin
Last updated: Friday, 28, January, 2011
| Causes | Appropriate Tests |
|---|---|
PUO is defined as undiagnosed fever of more than 3 weeks duration. | Careful and repeated clinical history and examination; FBC, blood film, differential WCC; CRP ; bilirubin, ALP, AST, ALT, GGT, LD. |
Bacterial infection, especially | Blood culture (repeated); urine microscopy and culture; faeces - microscopy, culture and antigen detection. |
Abscess, especially
| |
Ascending cholangitis | See Cholestasis |
Typhoid fever | |
| Urine for mycobacteria testing; collect early morning specimens (three). | |
Fungal infection | |
| Cryptococcal antigen - blood, CSF, if appropriate. | |
Protozoal infection | |
| Malaria parasites - blood - repeated thin and thick blood films, if indicated. | |
Viral infection | |
Drug fever | |
Malignancy, especially | FNAB, lesion biopsy; as appropriate. Tumour markers are unreliable as a screening test for occult malignancy. |
Renal cell carcinoma | |
Hepatocellular carcinoma | |
Disseminated carcinoma | |
Atrial myxoma | |
Other | |
Granulomatous hepatitis | See Hepatitis - Granulomatous |
Familial Mediterranean fever | Clinical diagnosis. CRP (intermittent elevation); biopsy of appropriate tissue only if clinical features suggest amyloidosis. |
Occult haematoma, especially
| |
Factitious fever |