Pyrexia of unknown origin

Fernández, Claudia Nélida; Beeching, Nicholas J.

doi:10.7861/clinmedicine.18-2-170

Cited by 32 publications

(41 citation statements)

References 18 publications

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“…Not only the number of patients but also the frequency of diagnostic categories can differ if various definitions for FUO are used. According to Vanderschueren et al, 43.9% of cases were in the category undiagnosed if the definition from 1991 was used, and 53.0% were undiagnosed according to 1961 definition; however, no significant differences in diagnostic categories among diagnosed cases were noted (8). In a systematic review, the frequency of FUO from neoplasms was lower in patients selected with the definition from 1991, and the frequency of FUO from non-infectious inflammatory disorders (NIIDs) was lower in patients with the third FUO definition (31).…”

Section: Definition Of Fuomentioning

confidence: 99%

“…Defining the necessary initial investigations to try to reach a diagnosis remains a matter of debate, but it is generally agreed that the standard initial diagnostic investigation protocol should at least include a comprehensive history and repeated physical examination, complete blood count with differential cell count, electrolytes, renal and liver function tests, protein electrophoresis, enzymes (alkaline phosphatase, aminotransferase, lactate dehydrogenase, creatine phosphokinase), CRP, ESR, microscopic urinalysis, three blood cultures (different sites, several hours apart), urine culture, chest X-ray, abdominal ultrasonography, a tuberculin skin test or interferon gamma release assay, which is quite often accompanied by testing for antinuclear antibodies, rheumatoid factor, and anti-HIV test (26,(29)(30)(31)(42)(43)(44). Further evaluations indicated by potentially diagnostic clues, which are defined as all localizing signs, symptoms, laboratory tests, and other abnormalities potentially pointing towards a diagnosis, can additionally be included (5,21,28,30,42).…”

Section: Uniform Initial Diagnostic Protocolmentioning

confidence: 99%

“…As an alternative for the group of NIIDs, different authors use other terminology and classifications, such as rheumatologic (24), inflammatory (43), rheumatologic/inflammatory (5,47), autoimmune (36), allergic and autoimmune (48), connective tissue (2, 49), inflammatory/connective tissue (50), or collagen vascular (6,12,37) disorders. In older studies, other classifications can be found in which in addition to the standard diagnostic categories (infections, neoplasms, miscellaneous, undiagnosed), the following are independent categories: inflammatory, collagen vascular and granulomatous diseases (7), collagen and granulomatous diseases (51), collagen, granulomatous diseases, periodic fever and factitious fever (52), multisystem diseases, drug fever, factitious fever and habitual hyperthermia (22), etc.…”

Section: Classification Of Diagnostic Categories and Their Distributionmentioning

confidence: 99%

“…Whipple's disease is usually part of the miscellaneous group but increasingly more frequently is part of the infection category (28,36,47,55). In different reports, Castleman's disease is included in the neoplastic group (20,56), miscellaneous group (6,29,42,57,58), or infectious diseases group (47,55), and atrial myxoma sometimes is classified in the miscellaneous group (28,42,51,52) and other times is classified in the neoplastic group (5,11,36,43,55). In some reports, Kikuchi disease (2,9,29,50,54,57) and Crohn's disease are classified as part of the miscellaneous group (6,21,37,(55)(56)(57)59), and in other reports, Kikuchi disease (5,49) and Crohn's disease (11,33,39) are in the NIIDs group.…”

Section: Distribution Of Different Diseases In Appropriate Categoriesmentioning

confidence: 99%

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Fever of Unknown Origin (FUO): towards uniform definitions and classification system

Bosilkovski¹

2020

Erciyes Med J

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Despite the great advancements seen in medicine in recent years, fever of unknown origin (FUO) remains a serious diagnostic challenge. Regardless of the etiological elucidation in many cases of FUO and the progress seen in the management of these patients, there are currently many weaknesses in this area as a result of inconsistency in the definition and interpretation of key terminology and the utilization of different definitions and classifications. As a result, there is confusion among medical practitioners about FUO, which leads to laborious and difficult comparisons among different case series. This study outlines the mismatch in terminology and diversity found in the classification of the conditions that cause FUO and emphasizes the discrepancies between what some terminology intends to represent and what it actually represents in reality. Thus, we attempted to determine an appropriate solution for established inconsistencies.

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Section: Definition Of Fuomentioning

confidence: 99%

Section: Uniform Initial Diagnostic Protocolmentioning

confidence: 99%

Section: Classification Of Diagnostic Categories and Their Distributionmentioning

confidence: 99%

Section: Distribution Of Different Diseases In Appropriate Categoriesmentioning

confidence: 99%

See 2 more Smart Citations

Fever of Unknown Origin (FUO): towards uniform definitions and classification system

Bosilkovski¹

2020

Erciyes Med J

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“…This view is also supported by national guidelines on encephalitis and meningitis. 1,2 We agree that testing is vital in this patient group, as not only can meningoencephalitis occur at HIV seroconversion, but HIV infection also widens the potential differential diagnosis of neurological infections. We suggest that it is also valuable to establish risk factors for HIV infection during history taking, as in the period of acute HIV infection diagnostic testing may be negative.…”

Section: Responsementioning

confidence: 99%

Comment on CME Infectious diseases

Birley

2018

Clinical Medicine

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A Nontrivial Analysis of Patient Safety Risk from Parenteral Drug- and Medical Device-Borne Endotoxin

Tidswell

2023

Drugs R D

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Background A thorough and systematic analysis of potential endotoxin-related safety issues from parenteral drugs and devices is important to ensure appropriate current Good Manufacturing Practices, compendial requirements, standards and regulatory guidance. Lately, the US Food and Drug Administration has been expecting pharmaceutical firms to apply an arbitrary safety factor to compendial compliant drug specifications for endotoxin, potentially causing manufacturing challenges, supply issues and additional unwarranted costs. Objective The aim of this study was to evaluate data from three disparate sources over an extended period of time, from 2008 to 2021, to determine if there exists an industry-wide risk to patients from parenteral drugs and devices, thereby evaluating if changes to current Good Manufacturing Practices or compendial requirements are indeed warranted. Food and Drug Administration data from current Good Manufacturing Practices non-compliance observations, product recalls and the FDA Adverse Event Reporting System were used as the three sources of data. Methods Parenteral products were separated into drugs and devices, potential endotoxin-related patient safety issues were characterised in terms of the available non-compliance information, the type and number of product recalls, and the type and number of potential adverse events. Descriptive statistics in Microsoft Excel 2019 and Pivot tables were used for the analysis and presentation of the data. Results From 2011 to 2021, a total of 188 endotoxin-related current Good Manufacturing Practices compliance observations were recorded, 70% and 30% were associated with laboratory and manufacturing origins, respectively. Finished drug product testing accounted for 56% of these. In contrast, 95% of all endotoxin-related product recalls were associated solely with medical devices. Over the years 2008–2021, approximately 1.4% of all adverse events (23,663,780) were recorded with some reference to pyrexia (fever); however, there are sparse data categorically attributing this to the administration of parenteral drugs or devices or combinations of these possessing high levels of endotoxin. Conclusions Analysis of data concerning drug- and device-borne endotoxin obtained from FDA data from current Good Manufacturing Practices non-compliance observations, product recalls and the FDA Adverse Event Reporting System demonstrated the absence of industry-wide issues with endotoxin contamination. Based upon these data, changes to current Good Manufacturing Practices and the compendial methodology of setting endotoxin specifications (and hence the compendial methodology of testing for endotoxins) are unwarranted.

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Pyrexia of unknown origin

Cited by 32 publications

References 18 publications

Fever of Unknown Origin (FUO): towards uniform definitions and classification system

Fever of Unknown Origin (FUO): towards uniform definitions and classification system

Comment on CME Infectious diseases

A Nontrivial Analysis of Patient Safety Risk from Parenteral Drug- and Medical Device-Borne Endotoxin

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