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[Management of prolonged fever of unknown origin]
Abstract:
Problems arisen with long lasting fevers of undetermined origin are frequently hard to resolve. Infectious diseases are the right diagnosis in less than 50% of patients, especially for very long lasting fevers and in the elderly. Complex investigation must start after the 15th day of evolution, and must proceed in a definite way. Laparotomy may be the last resort of investigation. Antibiotherapy is to be delayed as long as possible, but in several cases cannot be avoided, the choice of drugs being sometimes difficult.
Insights
Diagnosing prolonged fevers of unknown origin (FUO) is challenging, with infectious diseases identified in less than half of cases, particularly in the elderly. Investigations should be systematic after 15 days, with surgery as a last resort and antibiotics used judiciously.
Area of Science:
- Internal Medicine
- Infectious Diseases
- Diagnostic Challenges
Context:
- Prolonged fevers of unknown origin (FUO) present significant diagnostic difficulties.
- Infectious etiologies are identified in less than 50% of FUO cases.
- Elderly patients and those with very long-lasting fevers pose particular diagnostic challenges.
Purpose:
- To outline a systematic approach for investigating prolonged fevers of unknown origin.
- To emphasize the importance of a structured diagnostic pathway.
- To guide clinical decision-making regarding investigations and treatment.
Summary:
- Complex investigations for FUO should commence after 15 days of fever.
- A definitive and methodical investigative strategy is crucial.
- Surgical exploration (laparotomy) may be necessary as a final diagnostic step.
- Antimicrobial therapy should be delayed until necessary, with careful drug selection.
Impact:
- Improved diagnostic yield for fevers of unknown origin.
- Optimized patient management through a structured approach.
- Reduced unnecessary antimicrobial use and potential for antibiotic resistance.