Fever of Unknown Origin Treatment & Management
- Author: Kirk M Chan-Tack, MD; Chief Editor: Michael Stuart Bronze, MD more...
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.
Because of a better understanding of the etiologies and careful diagnostic approaches, patients with FUO rarely need surgical treatment.
No evidence supports prolonged hospitalization in patients who are clinically stable and whose workup findings are unrevealing.
Conduct close follow-up procedures and systematic reevaluation studies to prevent clinical worsening. Guide further workup studies on an outpatient basis.
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.
Appropriate consultations are indicated based on patient history, physical examination, laboratory data, and radiologic findings. Consultations include the following:
- Infectious disease specialist
- Interventional radiologist
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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