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Fever Of Unknown Origin

Author: Burke A. Cunha
Publisher: CRC Press
ISBN: 9781420019582
Size: 32.45 MB
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about the book... Assisting clinicians in the differential diagnosis of the wide range of disorders responsible for fever of unknown origin (FUO), this source stands as the only recent and comprehensive differential diagnosis of these conditions. This guide providing a clear overview of diagnostic approaches and offers expert recommendations that are invaluable to anyone caring for patients with prolonged undiagnosed fever. Written by clinicians for clinicians, this single authoritative source emphasizes the syadramic approach in the diagnosis of FUOs...discusses the etiology and distribution of disorders causing FUOs...and stresses the importance of a focused history, physical examination, and laboratory tests in the differential diagnosis of the FUO patient. about the editor... BURKE A. CUNHA is Chief, Infectious Disease Division, Winthrop-University Hospital, Mineola, New York, and Professor of Medicine, State University of New York School of Medicine, Stony Brook. Dr. Cunha is the author or coauthor of more than 150 abstracts, 100 electronic publications, 1000 articles, and 150 book chapters. He has edited 20 books on various infectious disease topics and is Editor-in-Chief of the journals Infectious Disease Practice and Antibiotics for Clinicians. Dr. Cunha is a Fellow of the Infectious Diseases Society of America. Dr. Cunha is internationally recognized as a teacher-clinician and is the recipient of many teaching awards including the prestigious Aesculapius Award. Dr. Cunha is a Master the American College of Physicians awarded for lifetime achievement as a master clinician and teacher of infectious diseases. Dr. Cunha received the M.D. degree from Pennsylvania State University College of Medicine, Hershey.

Fever Of Unknown Origin And Splenomegaly

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Size: 72.73 MB
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Abstract: Rationale: Fever of unknown origin (FUO) can be determined by different conditions among which infectious diseases represent the main cause. Patient concerns: A young woman, with a history of aortic stenosis, was admitted to our unit for a month of intermittent fever associated with a new diastolic heart murmur and splenomegaly. Laboratory tests were negative for infectious screening. The total body computed tomography (CT) scan excluded abscesses, occulted neoplasia, or lymphadenopathy. Diagnoses: The transthoracic and transesophageal echocardiogram showed an aortic valve vegetation. Three sets of blood cultures were negative for all microorganisms tested. According to these findings, Bartonella endocarditis was suspected and the serology tests performed were positive. Finally, real-time polymerase chain reaction (RT-PCR) detected Bartonella henselae DNA on tissue valve. Interventions: The patient underwent heart valve surgery and a treatment of Ampicillin, Gentamicin, and oral Doxycycline was prescribed for 16 days and, successively, with Doxycycline and Ceftriaxone for 6 weeks. Outcomes: After surgery and antibiotic therapy, patient continued to do well. Lessons: Bartonella species are frequently the cause of negative blood culture endocarditis. Molecular biology techniques are the only useful tool for diagnosis. Valvular replacement is often necessary and antibiotic regimen with Gentamicin and either Ceftriaxone or Doxycycline is suggested as treatment. Echocardiogram and blood cultures must be performed in all cases of FUO. When blood cultures are negative and echocardiographic tools are indicative, early use of Bartonella serology is recommended.

An Unusual Cause Of Fever Of Unknown Origin With Enlarged Lymph Nodes Relapsing Polychondritis

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Abstract: Introduction: Fever of unknown origin (FUO) is a common initial presentation leading to a diagnostic challenge. Patient concerns: A 3-month history of moderate-to-high fever was reported in an otherwise healthy 54-year-old man. Enhanced computed tomography (CT) scans of his chest showed a remarkable progressive enlargement of bilateral cervical, supraclavicular, hilar, and mediastinal lymph nodes within 2 weeks. Bronchofibroscopy manifested obvious luminal stenosis with swelling, thick pale mucosa, and disappearing of structures of trachea cricoid cartilage, followed by a 18F-fluorodeoxyglucose positron-emission tomography–computed tomography (18F-FDG PET/CT) with intense symmetric FDG uptake in larynx, tracheobronchial tree, and hilar, mediastinal, and axillary lymph nodes being demonstrated. Diagnosis: A diagnosis of relapsing polychondritis (RP) was finally reached. Interventions: The patient received methylprednisolone 40 mg daily with a gradual tapering in a 4-month follow-up. Outcomes: The patient experienced no relapse of fever and lymph nodes enlargement in the 4-month follow-up. Lessons: Even though long-term fever with multiple lymphadenectasis usually lead to a diagnosis of lymphoma, the bronchoscopic features and evidence from 18F-FDG PET/CT in this case were much more approximate to RP, indicating an importance of a sensible differential diagnosis of RP in patients who present with nonspecific features such as FUO and lymph nodes enlargement. Keeping a high index of clinical suspicion in these patients can help recognize uncommon of RP and promote diagnosis and treatment. Our case highlights the significance of 18F-FDG PET/CT in helping reaching the diagnosis of RP in this condition. This report provides new data regarding the diagnostic difficulties of this rare type of autoimmune disease, and further investigations are needed as cases accumulate.

Fever Of Unknown Origin A Rare Presentation Of Giant Hepatic Hemangioma

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Abstract Hepatic hemangioma is mostly asymptomatic and incidental finding on imaging. Fever of unknown origin as a sole presentation is rare. We present an interesting case report of a 49-year-old female, who presented with fever for three months. Extensive blood investigations and infectious workup failed to reveal the cause. Contrast computed tomography of abdomen revealed a giant (15 × 11 cm) hemangioma arising from left lateral segment of liver, and was attributed as a cause for fever. Surgical excision of hemangioma completely ameliorated the fever.

Combating Fever

Author: Arora Ritu
Publisher: B Jain Pub Pvt Limited
ISBN: 9788180561290
Size: 23.26 MB
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Sometime fever, which is a very common problem, can be very difficult to cure. This book is a comprehensive book on the subject which helps to deal with all type of fever.

Prolonged Fever Of Unknown Origin In Children

Author: Sics Editore
Publisher: SICS Editore
ISBN: 8869309975
Size: 24.33 MB
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The preliminary investigations of prolonged fever of unknown origin (FUO) in primary health care are ESR, full blood count and CRP urinalysis and bacterial culture imaging studies (chest x-ray, maxillary sinus imaging). If the blood picture is normal, CRP and ESR within normal limits and the fever is fluctuating and of low grade, a specific underlying cause is only rarely found. In these cases, fever gradually resolves in over 80% of children and no definite diagnosis is necessarily ever made . If the cause of fever remains unknown, the blood picture has abnormal features, the inflammatory markers are elevated or empiric antimicrobials are considered, investigations are continued in specialist health care. Fever in infants under the age of 3 months requires urgent management .