Fever of unknown origin

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Classification according to ICD-10
R50 Fever of unknown origin
ICD-10 online (WHO version 2019)

Fever of unknown origin , and fever of unknown origin ( Engl. Fever of unknown origin (FUO), lat. Febris e causa ignota (febris ECI)), is the name given to a measured at different times body temperature higher than 38.3 ° C for a period of more than three weeks without the cause being able to be determined after multiple medical diagnostics .

The diagnosis of fever of unknown origin is not a disease in its own right , but rather a "diagnosis of embarrassment" made due to limited diagnostic possibilities. FUO is - like fever in general - a symptom of many different diseases. In most cases, the disease underlying the fever can be diagnosed later.

definition

Originally, fever of unclear origin was defined in 1961 by Robert G. Petersdorf and Paul B. Beeson  - who also coined the Anglo-Saxon term fever of unexplained origin - as follows:

  • The patient is sick for at least three weeks.
  • The fever was several times higher than 38.3 ° C during this time.
  • Despite an intensive examination in an inpatient stay of one week, no illness causing the fever can be diagnosed.

Thirty years after this definition, DT Durack and AC Street redefined the third criterion of fever of unclear origin in 1991, with a three-day inpatient hospital stay or three outpatient visits being sufficient.

In addition, they were divided into four classes, which is still valid:

  1. classic fever of unknown origin
  2. nosocomial fever of unknown origin
  3. Neutropenic fever of unknown origin and fever of unknown origin in immunosuppression
  4. Fever of unknown origin in HIV patients

The classic fever of unclear origin can in turn be subdivided into five categories: into infections , cancer , autoimmune diseases , manipulation (fake fever, drug fever) and unexplained causes.

According to recent studies, autoimmune diseases are the most common cause of fever of unknown origin. This includes connective tissue diseases , vasculitides and granulomatous diseases . Cancer is also a very common cause of fevers of unknown origin.

diagnosis

Fever of unknown origin can easily be determined using the definition by repeatedly measuring the body temperature over a period of at least three weeks. However, fever is only a symptom of an illness and the primary goal of FUO is to diagnose the underlying illness in order to initiate appropriate therapy . However, there are currently no guidelines for diagnosing the cause of FUO based on evidence . A detailed medicine , clinical examination and laboratory diagnostics are the basis for all further examinations.

A helpful, but also very complex, diagnostic method is positron emission tomography with fluorodeoxyglucose (FDG-PET). This imaging method can be used to localize cancer as well as inflammation and infections.

therapy

As long as the cause of the fever has not been determined and the patient is not acutely ill, therapeutic measures are largely pointless. Nonspecific therapeutic measures are of little use and are usually more of a hindrance to the diagnosis.

forecast

The causes of FUO are very complex in nature. The prognosis depends accordingly on the illness causing the fever. If no disease has been diagnosed after six months, the prognosis is generally good.

literature

Individual evidence

  1. ^ RG Petersdorf and PB Beeson: Fever of unexplained origin: report on 100 cases. In: Medicine. Volume 40, February 1961, pp. 1-30, ISSN  0025-7974 . PMID 13734791 .
  2. ↑ a b F. Thalhammer: DFP-Allgemeinemedizin: Fever of unknown cause In: Ärztemagazin 2, 2008
  3. ^ DT Durack, AC Street: Fever of unknown origi - reexamined and redefined. In: Current clinical topics in infectious diseases. Volume 11, 1991, pp. 35-51, ISSN  0195-3842 . PMID 1651090 . (Review).
  4. ^ S. Vanderschueren, D. Knockaert, T. Adriaenssens, W. Demey, A. Durnez, D. Blockmans, H. Bobbaers: From prolonged febrile illness to fever of unknown origin: the challenge continues. In: Archives of internal medicine . Volume 163, Number 9, May 2003, pp. 1033-1041, ISSN  0003-9926 . doi : 10.1001 / archinte.163.9.1033 . PMID 12742800 .
  5. ↑ E. Märler-Hermann and JF Riemann: Fever of unclear origin. In: Der Internist 50, 2009, pp. 653–655. doi : 10.1007 / s00108-009-2412-0
  6. ^ J. Williams, R. Bellamy: Fever of unknown origin. In: Clinical medicine. Volume 8, Number 5, October 2008, pp. 526-530, ISSN  1470-2118 . PMID 18975488 . (Review).
  7. ↑ DC Knockaert, S. Vanderschueren, D. Blockmans: Fever of unknown origin in adults: 40 years on. In: Journal of internal medicine. Volume 253, Number 3, March 2003, pp. 263-275, ISSN  0954-6820 . PMID 12603493 . (Review).
  8. ↑ E. Andres, L. Federici, A. Imperiale: Value of 18 FDG-PET / CT in clinical practice in patients with fever of unknown origin and unexplained prolonged inflammatory syndrome. In: European journal of radiology. Volume 75, Number 1, July 2010, p. 122, ISSN  1872-7727 . doi : 10.1016 / j.ejrad.2009.04.067 . PMID 19497693 .
  9. ↑ L. Federici, C. Blondet, A. Imperiale, J. Sibilia, JL Pasquali, F. Pflumio, B. Goichot, G. Blaison, JC Weber, D. Christmann, A. Constantinesco, E. Andrès: Value of ( 18) F-FDG-PET / CT in patients with fever of unknown origin and unexplained prolonged inflammatory syndrome: a single center analysis experience. In: International journal of clinical practice. Volume 64, Number 1, January 2010, pp. 55-60, ISSN  1742-1241 . doi : 10.1111 / j.1742-1241.2008.01774.x . PMID 18479364 .
  10. ↑ J. Meller, CO Sahlmann, O. Gürocak, T. Liersch, B. Meller: FDG-PET in patients with fever of unknown origin: the importance of diagnosing large vessel vasculitis. In: The quarterly journal of nuclear medicine and molecular imaging. Volume 53, Number 1, February 2009, pp. 51-63, ISSN  1824-4785 . PMID 19182728 . (Review).
  11. ^ CP Bleeker-Rovers, JW van der Meer, WJ Oyen: Fever of unknown origin. In: Seminars in nuclear medicine. Volume 39, Number 2, March 2009, pp. 81-87, ISSN  1558-4623 . doi : 10.1053 / j.semnuclmed.2008.10.002 . PMID 19187801 . (Review).
  12. ↑ DA Warrell et al. a. (Ed.): The Oxford Textbook of Medicine. Oxford University Press, 2003, ISBN 0-19-262922-0 .
  13. ↑ CS Bryan, D. Ahuja: Fever of unknown origin: is there a role for empiric therapy? In: Infectious disease clinics of North America. Volume 21, Number 4, December 2007, pp. 1213-20, xi, ISSN  0891-5520 . doi : 10.1016 / j.idc.2007.08.007 . PMID 18061094 . (Review).