Causes for Long-lasting Fever

Fever for more than 3 weeks

Known as

Pyrexia of Unknown Origin (PUO)

•Fever persisting above 38. 0 0C •for more than 3 weeks •with no clear diagnosis •despite intelligent and intensive investigation.

Major Causes

2/3 of cases• Infection

Other 1/3• Malignancy • Autoimmune rheumatic disorders• Vasculitides• Miscellaneous

Infective Causes

General Specific

Infective Causes - General Infections

Abscesses

• Hepatobilliary• Abdomen• Pelvis• Ear• Sinus• Dental

Infective endocardiatis

Urinary tract infection

Infective Causes - Specific Infections

BacterialViral

ProtozoalRickettsial diseases

Chalmydophilia

•Myobacterium tuberculosis•Salmonella typhi / Salmonella paratyphi•Brucella spp.•Leptospirosis•Lyme disease

Bacterial

•HIV•Epstein Barr virus (EBV)•Dengue fever•Hepatits•Cytomegalovirus (CMV)

Viral

•Malaria•Amoebiasis•Leishmannia spp.•Toxoplasmosis•trypanosomiasis

Protozoal

• Typhus• Q feverRickettsial diseases

• Psittacosis

Chalmydophilia

Malignancy ~ 20%

•Lymphoma •Leukaemia•Myeloma

Haematological malignancy

•Renal •Liver •Colon•Stomach•Pancreas

Solid tumours

Autoimmune Rheumatic Disorders

Fibromyalgia

Gout

Infectious arthritis

Juvenile idiopathic arthritis

Lupus

Osteoarthritis

Miscellaneous

Cardiovascular

Respiratory

Gastrointestinal

Endocrine/ metabolic

Haematological

Inherited

Drug reactions

Idopathic

Cardiovascular

• Arial myxoma

• Aortitis

• Aortic dissection

Respiratory

Gastrointestinal

Endocrine/ metabolic

Haematological

Inherited

• Familial Mediterranean fever• Periodic fever syndrome

Drug reactions

• Antibiotic fever• Drug hypersensitivity reactions

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