Mobile Infirmary Journal Club Presentation
Fever of unknown origin is a diagnostic paradigm to evaluate prolonged febrile illness without an established etiology despite intensive evaluation and diagnostic testing. Follow along with this presentation as Jonathan Desimone, Alabama College of Osteopathic Medicine's Class of 2023 D.O. Candidate, presents this journal club presentation at the Mobile Infirmary Journal Club based on an article from the NEJM published February of 2022.
Questions to Consider
•How do we regulate our temperature and what is the mechanism of the febrile response?
•What are the benefits of fever?
•What is Fever of Unknown Origin?
•How has Fever of Unknown Origin changed over the years?
•How do you go about approaching the diagnosis and treatment of a patient with Fever of Unknown Origin?
Overview of Material Covered
•Thermoregulation and the Febrile Response
•What is Fever of Unknown Origin (FUO)
•Categorical Evaluation of FUO
•Approach to Diagnosis
•Approach to Management
•Future Considerations
•Case Studies
Sources
1.Main NEJM Journal Article: Haidar, G. and N. Singh (2022). "Fever of Unknown Origin." New England Journal of Medicine 386(5): 463-477. https://www-nejm-org.acom.idm.oclc.org/doi/full/10.1056/NEJMra2111003
2.Medical Physiology Textbook: Boron, W. F., & Boulpaep, E. L. (2016). Medical Physiology E-Book. Saintt Louis: Elsevier.
3.Febrile Response Image: Ogoina, D. (2011). Fever, fever patterns and diseases called ’fever’--a review. Journal of Infection and Public Health, 4(3), 108–124. https://doi.org/10.1016/j.jiph.2011.05.002
4.Definition of FUO: PETERSDORF RG, BEESON PB. Fever of unexplained origin: report on 100 cases. Medicine (Baltimore). 1961 Feb;40:1-30. doi: 10.1097/00005792-196102000-00001. PMID: 13734791.
5.Fever of Unknown Origin by Decade from UpToDate: Mourad O, Palda V, Detsky AS. Arch Intern Med 2003; 163:545.
6.Change in Fever of Unknown Origin Over Time: Bosilkovski M, Dimzova M, Cvetkova M, Poposki K, Spasovska K, Vidinic I. The changing pattern of fever of unknown origin in the Republic of North Macedonia. Rom J Intern Med. 2019 Sep 1;57(3):248-253. doi: 10.2478/rjim-2019-0007. PMID: 30862765.
7.Outcome for Undiagnosed FUO: Knockaert DC, Dujardin KS, Bobbaers HJ. Long-term follow-up of patients with undiagnosed fever of unknown origin. Arch Intern Med. 1996 Mar 25;156(6):618-20. PMID: 8629872.
8.Procalcitonin : Velissaris D, Zareifopoulos N, Lagadinou M, Platanaki C, Tsiotsios K, Stavridis EL, Kasartzian DI, Pierrakos C, Karamouzos V. Procalcitonin and sepsis in the Emergency Department: an update. Eur Rev Med Pharmacol Sci. 2021 Jan;25(1):466-479. doi: 10.26355/eurrev_202101_24416. PMID: 33506938.
9.TB Prevalence: MacNeil A, Glaziou P, Sismanidis C, Maloney S, Floyd K. Global Epidemiology of Tuberculosis and Progress Toward Achieving Global Targets — 2017. MMWR Morb Mortal Wkly Rep 2019;68:263–266. DOI: http://dx.doi.org/10.15585/mmwr.mm6811a3external icon
10.Examples of Zoonotic Diseases and Their Affected Populations Infographic: https://www.gao.gov/products/gao-12-55
11.Endemic mycoses: Ashraf N, Kubat RC, Poplin V, Adenis AA, Denning DW, Wright L, McCotter O, Schwartz IS, Jackson BR, Chiller T, Bahr NC. Re-drawing the Maps for Endemic Mycoses. Mycopathologia. 2020 Oct;185(5):843-865. doi: 10.1007/s11046-020-00431-2. Epub 2020 Feb 10. PMID: 32040709; PMCID: PMC7416457.
12.Vector-borne Diseases Infographic: https://www.who.int/news-room/fact-sheets/detail/vector-borne-diseases
13.Immunology Textbook: Abbas, A. K., Lichtman, A. H., Pillai, S., & Elsevier (Amsterdam). (2020). Basic immunology: Functions and disorders of the immune system. Philadelphia: Elsevier.
14.Naproxen Challenge: Zhang, H., Wu, Y., Lin, Z., Zhong, X., Liu, T., Huang, Z., & Yang, Y. (2019). Naproxen for the treatment of neoplastic fever: A PRISMA-compliant systematic review and meta-analysis. Medicine, 98(22), e15840. https://doi.org/10.1097/MD.0000000000015840
15.Common Disease of HIV Positive Adults: LE, T. A. O. (2021). FIRST AID FOR THE USMLE STEP 1 2022. S.l.: MCGRAW-HILL EDUCATION.
16.Opportunistic Infections Infographic: http://www.4woman.org/hiv/livingwith/ois/
17.Where Malaria Occurs Infographic: https://www.cdc.gov/malaria/about/distribution.html
18.Medical Microbiology Textbook: Riedel, S., Hobden, J. A., Miller, S., Morse, S. A., Mietzner, T. A., Detrick, B., Mitchell, T. G., ... Hotez, P. (2019). Jawetz, Melnick & Adelberg's medical microbiology. New York, NY: McGraw-Hill Education.
19.Case Report 1: Burzo, M. L., Antonelli, M., Pecorini, G., Favuzzi, A. M. R., Landolfi, R., & Flex, A. (2017). Fever of unknown origin and splenomegaly: A case report of blood culture negative endocarditis. Medicine, 96(50), e9197. https://doi.org/10.1097/md.0000000000009197
20.B. henselae Life Cycle: Gouriet, Frédérique & Lepidi, Hubert & Habib, Gilbert & Collart, Frédéric & Raoult, Didier. (2007). From cat scratch disease to endocarditis, the possible natural history of Bartonella henselae infection. BMC infectious diseases. 7. 30. 10.1186/1471-2334-7-30.
21.Case Report 2: Schmidt MQ, Altoos R, Kwak JJ. 18F-fluorodeoxyglucose positron emission tomography/computed tomography in the diagnosis of a rare mycotic aneurysm of the thoracic aorta in a patient with fever of unknown origin. World J Nucl Med 2021;20:305-8.
22.Stages in PET imaging of the human body: Patching SG. Roles of facilitative glucose transporter GLUT1 in [18F]FDG positron emission tomography (PET) imaging of human diseases. J. Diagn. Imaging Ther. 2015; 2(1): 30-102 (https://dx.doi.org/10.17229/jdit.2015-0301-014).
23.Case Report 3: Hardal, C., Erguven, M., & Saglam, Z. A. (2017). Systemic Juvenile İdiopathic Arthritis as a cause of fever of an unknown origin. Northern Clinics of Istanbul, 4(1), 81–84. https://doi.org/10.14744/nci.2016.07769
24.Pediatric Vital Sign Range: Sapra A, Malik A, Bhandari P. Vital Sign Assessment. [Updated 2021 May 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553213/
25.Juvenile Idiopathic Arthritis Infographic: In Ludwig, S., In Netter, F. H., & In Florin, T. A. (2013). Netter's pediatrics.
26.Quick Review of Hypersensitivity Types: LE, T. A. O. (2021). FIRST AID FOR THE USMLE STEP 1 2022. S.l.: MCGRAW-HILL EDUCATION.