tailieunhanh - Chapter 019. Fever of Unknown Origin (Part 2)

Infections, especially extrapulmonary tuberculosis, remain the leading diagnosable cause of FUO. Prolonged mononucleosis syndromes caused by Epstein-Barr virus, cytomegalovirus (CMV), or HIV are conditions whose consideration as a cause of FUO is sometimes confounded by delayed antibody responses. Intraabdominal abscesses (sometimes poorly localized) and renal, retroperitoneal, and paraspinal abscesses continue to be difficult to diagnose. Renal malacoplakia, with submucosal plaques or nodules involving the urinary tract, may cause FUO and is often fatal if untreated. It is associated with intracellular bacterial infection, is seen most often in patients with defects of intracellular bacterial killing, and is treated with fluoroquinolones. | Chapter 019. Fever of Unknown Origin Part 2 Infections especially extrapulmonary tuberculosis remain the leading diagnosable cause of FUO. Prolonged mononucleosis syndromes caused by Epstein-Barr virus cytomegalovirus CMV or HIV are conditions whose consideration as a cause of FUO is sometimes confounded by delayed antibody responses. Intraabdominal abscesses sometimes poorly localized and renal retroperitoneal and paraspinal abscesses continue to be difficult to diagnose. Renal malacoplakia with submucosal plaques or nodules involving the urinary tract may cause FUO and is often fatal if untreated. It is associated with intracellular bacterial infection is seen most often in patients with defects of intracellular bacterial killing and is treated with fluoroquinolones or trimethoprim-sulfamethoxazole. Occasionally other organs may be involved. Osteomyelitis especially where prosthetic devices have been implanted and infective endocarditis must be considered. Although true culture-negative infective endocarditis is rare one may be misled by slow-growing organisms of the HACEK group Haemophilus aphrophilus Actinobacillus actinomycetemcomitans Cardiobacterium hominis Eikenella corrodens and Kingella kingae Chap. 140 Bartonella spp. previously Rochalimaea Legionella spp. Coxiella burnetii Chlamydophila psittaci and fungi. Prostatitis dental abscesses sinusitis and cholangitis continue to be sources of occult fever. Fungal disease most notably histoplasmosis involving the reticuloendothelial system may cause FUO. FUO with headache should prompt examination of spinal fluid for Cryptococcus neoformans. Malaria which may result from transfusion the failure to take a prescribed prophylactic agent or infection with a drug-resistant strain continues to be a cause particularly of asynchronous FUO. A related protozoan infection babesiosis may cause FUO and is increasing in geographic distribution and in incidence especially among the elderly and immunosuppressed. In most .