Initial Management of FUO in ED
1Emergency Medicine, Woodlands Health Campus, Singapore
One of the conditions increasingly encountered in emergency medicine is the diagnosis of prolonged fever without localizing signs of disease. This problem perplexes both the emergency physician as well as the patient.
Fever of unknown origin (FUO) is traditionally defined as fever higher than 38.3oC on several occasions for at least three weeks with uncertain diagnosis after one week of evaluation. In some definitions, this applies to one week of in-hospital evaluation, whilst some experts have broadened the definition to allow for outpatient evaluation.
The four categories of potential etiology of FUO are classic, nosocomial, immune deficient and human immunodeficiency virus (HIV)-related. Furthermore, the causes of FUO often have an overlapping collection of symptoms and insidious disease courses. FUO is most commonly an atypical presentation of a common condition rather than a common presentation of a rare disease.
Less is known about how to investigate and manage the adult patient who presents with an acute febrile illness with no localizing symptoms in the ED. A thorough history, physical examination and standard laboratory testing remain the basis of the initial evaluation of the patient with FUO. Newer diagnostic modalities can aid in the diagnosis. Moreover, there is no clear consensus in the literature for defining the minimal diagnostic evaluation in the ED. Treatment is empirical if a cause is not found .and the management individualized for each clinical scenario comprises the ideal treatment in the acute setting.