Sunday, January 15, 2006

fever of undetermined origin

Patients who maintain a temperature of 101 degrees Fahrenheit or greater for more than three weeks and have undergone screening evaluation with no firm diagnosis are said to have fever of undetermined origin. In general the elderly person with fever of undetermined origin is more likely to have a serious illness than a younger individual. The most common etiologies encountered in fever of undetermined origin are infectious, neoplastic, and inflammatory. The infectious illnesses include intra-abdominal (liver, gallbladder), endocarditis, and tuberculosis. Neoplastic diseases such as lymphoma (neoplastic disease of lymphoid tissue), nephrocarcinoma and metastatic tumors to the liver may also cause fever. Those illnesses frequently found in the inflammatory category are lupus erythematosus (systemic subacute skin lesions, usually chronic), polyarteritis nodosa (inflammation and necrosis of arteries), and giant-cell arteritis. For 5 percent to 15 percent of cases an etiology is never found.
Symptoms are extremely varied. Generally, however, the person does not manifest the usual symptoms of the disease in question. Every patient with an unexplained fever should have a thorough medical history and careful physical examination, which should be repeated at frequent intervals. A systematic approach to laboratory testing should be employed with follow-up of any leads. Specific abdominal tests may be necessary as well as bone marrow examination and liver biopsy. Abdominal exploration may be indicated in selected patients.
Covington, T., and Walker, J. Current Geriatric Therapy. Philadelphia: W. B. Saunders, 1984.

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