Written by : Dr. Urusa I Inamdar

Clinical signs:

• Fever from an infection often presents with night sweats and weight loss.
• In a rheumatological cause patient present with:

1. Arthralgia
2. Myalgias
3. Fatigue

• In cancer patients, the presentation is more likely:

1. Pain
2. Lack of appetite

Physical examination – Infectious disease:

Physical findings with specific significance in patients:

Non imaging test for PUO:

Diagnostic imaging in patients with PUO:

Treatment:

In the majority of cases, treatment other than supportive care should not be commenced until a diagnosis is obtained. Early use of antipyretics or antimicrobial may delay diagnosis. The mortality rate for PUO is less than 10%.

If infective endocarditis is suspected, then the patient should be admitted to a hospital and empiric intravenous antibiotics should be commenced after three sets of blood cultures have been collected.

The recommended empiric regimen of infective endocarditis in Australia is gentamycin , benzylpenicillin and flucloxacillin; however this may vary with different patient factors and should be discussed with an infectious disease specialist.

References:

• Davidson’s- Principles and practice of medicine
• Gsk – webevent console
• onlinelibrary.wiley.com
• Dental notes