Fever of Unknown Origin Treatment & Management

Author: Kirk M Chan-Tack, MD; Chief Editor: Burke A Cunha, MD more...

Updated: Mar 29, 2011

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Approach Considerations
Surgical Care
Inpatient Treatment
Outpatient Care
Patient Transfer
Consultations
Long-Term Monitoring
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References

Approach Considerations

In general, empiric therapy has little or no role in cases of classic fever of unknown origin (FUO).

Treatment should be directed toward the underlying cause, as needed, once a diagnosis is made.

Some studies suggest a few exceptions to this general approach, including the following:

Cases that meet criteria for culture-negative endocarditis
Cases in which findings or the clinical setting suggests cryptic disseminated TB (or, occasionally, other granulomatous infections)
Cases in which temporal arteritis with vision loss is suspected.

Several studies have found that prolonged, undiagnosed FUO generally carries a favorable prognosis.

Surgical Care

Because of a better understanding of the etiologies and careful diagnostic approaches, patients with FUO rarely need surgical treatment.

Inpatient Treatment

No evidence supports prolonged hospitalization in patients who are clinically stable and whose workup findings are unrevealing.

Outpatient Care

Conduct close follow-up procedures and systematic reevaluation studies to prevent clinical worsening. Guide further workup studies on an outpatient basis.

Patient Transfer

The need for transfer is indicated if (1) the current facility is unable to establish a diagnosis, (2) diagnostic tests are unavailable at the existing facility, or (3) the patient deteriorates clinically.

Consultations

Appropriate consultations are indicated based on patient history, physical examination, laboratory data, and radiologic findings. Consultations include the following:

Infectious disease specialist
Hematologist/oncologist
Rheumatologist
Pulmonologist
Gastroenterologist
Endocrinologist
Interventional radiologist
Surgeon

Long-Term Monitoring

Problems may arise in the 5-15% of patients whose FUO remains undiagnosed, even after extensive evaluations. These patients usually have a benign long-term course, but close follow-up and systematic reevaluation studies are essential to avoid missing potential etiologies.

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Contributor Information and Disclosures

Author

Kirk M Chan-Tack, MD Medical Officer, Division of Antiviral Products, Center for Drug Evaluation and Research, Food and Drug Administration

Disclosure: Nothing to disclose.

Coauthor(s)

John Bartlett, MD Chief of Division of Infectious Diseases, Chief of HIV Care Service, Professor, Department of Internal Medicine, Johns Hopkins University School of Medicine

John Bartlett, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Clinical Pharmacology, American College of Physicians, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, American Thoracic Society, American Venereal Disease Association, Association of American Physicians, Infectious Diseases Society of America, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Charles V Sanders, MD Edgar Hull Professor and Chairman, Department of Internal Medicine, Professor of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine at New Orleans; Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans; Consulting Staff, Ochsner Medical Center

Charles V Sanders, MD is a member of the following medical societies: Alliance for the Prudent Use of Antibiotics, Alpha Omega Alpha, American Association for the Advancement of Science, American Association of University Professors, American Clinical and Climatological Association, American College of Physician Executives, American College of Physicians, American Federation for Medical Research, American Foundation for AIDS Research, American Geriatrics Society, American Lung Association, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Association for Professionals in Infection Control and Epidemiology, Association of American Medical Colleges, Association of American Physicians, Association of Professors of Medicine, Infectious Disease Society for Obstetrics and Gynecology, Infectious Diseases Society of America, Louisiana State Medical Society, Orleans Parish Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine, Southeastern Clinical Club, Southern Medical Association, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology

Disclosure: Baxter International and Johnson & Johnson Royalty Other

Chief Editor

Burke A Cunha, MD Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

Ergönül O, Willke A, Azap A, et al. Revised definition of 'fever of unknown origin': limitations and opportunities. J Infect. Jan 2005;50(1):1-5. [Medline].
Cunha BA. Fever of Unknown Origin. New York, NY: Informa Healthcare; 2007.
Bleeker-Rovers CP, Vos FJ, de Kleijn EM, Mudde AH, Dofferhoff TS, Richter C, et al. A prospective multicenter study on fever of unknown origin: the yield of a structured diagnostic protocol. Medicine (Baltimore). Jan 2007;86(1):26-38. [Medline].
Gaeta GB, Fusco FM, Nardiello S. Fever of unknown origin: a systematic review of the literature for 1995-2004. Nucl Med Commun. Mar 2006;27(3):205-11. [Medline].
Goldman RD, Scolnik D, Chauvin-Kimoff L, Farion KJ, Ali S, Lynch T, et al. Practice variations in the treatment of febrile infants among pediatric emergency physicians. Pediatrics. Aug 2009;124(2):439-45. [Medline].
Wagner AD, Andresen J, Raum E, et al. Standardised work-up programme for fever of unknown origin and contribution of magnetic resonance imaging for the diagnosis of hidden systemic vasculitis. Ann Rheum Dis. Jan 2005;64(1):105-10. [Medline].
Bleeker-Rovers CP, van der Meer JW, Oyen WJ. Fever of unknown origin. Semin Nucl Med. Mar 2009;39(2):81-7. [Medline].
Ozaras R, Celik AD, Zengin K, et al. Is laparotomy necessary in the diagnosis of fever of unknown origin?. Acta Chir Belg. Feb 2005;105(1):89-92. [Medline].

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