ID FUO_Septic Shock
Criteria for fever of unknown origin (FUO) Fever >38.3 (100.9ºF) on several occasions
Duration of fever for at least 3 weeks
Uncertain diagnosis after one week of study in the hospital
What accounts for a majority of FUO cases? Infections
Malignancies
Systemic rheumatic/Non-infectious inflammatory diseases
Misc. Cirrhosis, thyroiditis, PE, Chrohn's, drugs
Infections that cause FUO Bacterial: Endocarditis, tuberculosis, UTI, etc.
Viral: CMV, EMB, HIV
Parasitic: Malaria, Sleeping sickness, etc.
Malignancy found in FUO leukemia, lymphoma
hepatic, renal, colon
atrial myxoma
Noninfectious inflammatory causes of FUO CT diseases, vasculitis syndromes, granulomatous disease
Misc. causes of FUO Subacute thyroiditis, dressler syndrome, PE, addison disease
Drug fever/reactions
When can you make a dx of FUO? Both blood cultures and CXR are negative
Tests determining FUO H&P
CBC
Routine blood chemistries
U/A
Blood cultures (3 dif sets)
Chest radiograph
What tests to run for inflammation being cause of FUO? Erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP)
What tests to run for tissue damage being cause of FUO? Serum lactate dehydrogenase (LDH)
What tests to run for Blood/TB being cause of FUO? Tuberculin skin test or interferon-gamma release assay
What tests to run for high risk pts w/ FUO? HIV immunoassay and HIV viral load
What tests to run for damage to heart, brain, or muscle Creatine phosphokinase (CPK)
tissue being cause of FUO?
What tests to run for Mono; EBV infection being cause of Heterophile antibody test
FUO?
, ID FUO_Septic Shock
What tests to run for autoimmune; rheumatologic being Antinuclear antibodies (ANA)
cause of FUO? Rheumatoid factor (RF)
What is serum protein electrophoresis assessing for in Blood cancers
FUO? Liver dz
Monoclonal gammopathies
Polyclonal gammopathies
Renal dz
Monoclonal gammopathies Multiple myeloma, non-hodgkin lymphona, amyloidosis
Polyclonal gammopathies endocarditis, TB, CT/autoimmune, Rheumatic disorders, HIV
CT scans to assess cause of FUO Abdomen and chest
Diagnostic algorithm for FUO Lab testing -> d/c all meds -> CT chest/abdomen/pelvis -> ECHO -> nuclear scans -
> leg dopplers -> if >50 y/o, temporal artery biopsy -> No diagnosis
Empiric rx for FUO Antipyretics (NSAIDs, antihistamines)
Abx/antivirals/TB meds, steroids (carefully)
Bacteremia Presence of bacteria in the bloodstream
Causes of sepsis w/o bacteremia Localized infection
Toxins/cytokines
Fungal etiology
Prior abx kill off bacteria
Percentage of pt w/ sepsis AND detectable bacteremia 25%
Diagnosis of bacteremia is based off of what? Blood culture results
Blood culture in dx bacteremia -Prior to initiation of antimicrobial therapy
-2 sets of blood cultures taken from separate venipuncture sites
-Both aerobic and anaerobic bottles
-Obtained via venipuncture to decrease contamination
How many days for culture determination? 5 day incubation sufficient for most organisms
How many hours of incubation reveals a majority of 48 hours
clinically significant bacteremia?
Criteria for fever of unknown origin (FUO) Fever >38.3 (100.9ºF) on several occasions
Duration of fever for at least 3 weeks
Uncertain diagnosis after one week of study in the hospital
What accounts for a majority of FUO cases? Infections
Malignancies
Systemic rheumatic/Non-infectious inflammatory diseases
Misc. Cirrhosis, thyroiditis, PE, Chrohn's, drugs
Infections that cause FUO Bacterial: Endocarditis, tuberculosis, UTI, etc.
Viral: CMV, EMB, HIV
Parasitic: Malaria, Sleeping sickness, etc.
Malignancy found in FUO leukemia, lymphoma
hepatic, renal, colon
atrial myxoma
Noninfectious inflammatory causes of FUO CT diseases, vasculitis syndromes, granulomatous disease
Misc. causes of FUO Subacute thyroiditis, dressler syndrome, PE, addison disease
Drug fever/reactions
When can you make a dx of FUO? Both blood cultures and CXR are negative
Tests determining FUO H&P
CBC
Routine blood chemistries
U/A
Blood cultures (3 dif sets)
Chest radiograph
What tests to run for inflammation being cause of FUO? Erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP)
What tests to run for tissue damage being cause of FUO? Serum lactate dehydrogenase (LDH)
What tests to run for Blood/TB being cause of FUO? Tuberculin skin test or interferon-gamma release assay
What tests to run for high risk pts w/ FUO? HIV immunoassay and HIV viral load
What tests to run for damage to heart, brain, or muscle Creatine phosphokinase (CPK)
tissue being cause of FUO?
What tests to run for Mono; EBV infection being cause of Heterophile antibody test
FUO?
, ID FUO_Septic Shock
What tests to run for autoimmune; rheumatologic being Antinuclear antibodies (ANA)
cause of FUO? Rheumatoid factor (RF)
What is serum protein electrophoresis assessing for in Blood cancers
FUO? Liver dz
Monoclonal gammopathies
Polyclonal gammopathies
Renal dz
Monoclonal gammopathies Multiple myeloma, non-hodgkin lymphona, amyloidosis
Polyclonal gammopathies endocarditis, TB, CT/autoimmune, Rheumatic disorders, HIV
CT scans to assess cause of FUO Abdomen and chest
Diagnostic algorithm for FUO Lab testing -> d/c all meds -> CT chest/abdomen/pelvis -> ECHO -> nuclear scans -
> leg dopplers -> if >50 y/o, temporal artery biopsy -> No diagnosis
Empiric rx for FUO Antipyretics (NSAIDs, antihistamines)
Abx/antivirals/TB meds, steroids (carefully)
Bacteremia Presence of bacteria in the bloodstream
Causes of sepsis w/o bacteremia Localized infection
Toxins/cytokines
Fungal etiology
Prior abx kill off bacteria
Percentage of pt w/ sepsis AND detectable bacteremia 25%
Diagnosis of bacteremia is based off of what? Blood culture results
Blood culture in dx bacteremia -Prior to initiation of antimicrobial therapy
-2 sets of blood cultures taken from separate venipuncture sites
-Both aerobic and anaerobic bottles
-Obtained via venipuncture to decrease contamination
How many days for culture determination? 5 day incubation sufficient for most organisms
How many hours of incubation reveals a majority of 48 hours
clinically significant bacteremia?
