Description

The diagnosis of fever of unknown origin requires a persistent fever, the cause of which is not evident despite a complete evaluation. Mourad et al listed what the minimum requirements are for such an evaluation. The authors are from the University of Toronto, St. Michael's Hospital and Mt Sinai Hospital in Toronto.


 

Patient selection: presence of fever for > 3 weeks

 

Medical assessment:

(1) complete history, including occupational, recreational and travel history

(2) complete and careful physical examination

 

Laboratory evaluation:

(1) complete blood count (CBC)

(2) peripheral blood smear reviewed by a capable physician

(3) complete metabolic panel

(4) liver function tests including LDH and serum bilirubin

(5) urinalysis with examination of the urinary sediment

(6) rheumatoid factor (RF) and antinuclear antibodies (ANA)

(7) antibody to HIV

(8) IgM antibodies to CMV and EBV

(9) blood cultures for bacteria x3

(10) urine culture for bacteria

 

Additional testing if risk factors present or abnormal LFTs:

(1) IgM antibodies to Q fever

(2) serologic testing for hepatitis B and C

 

Imaging studies:

(1) chest X-ray

 

Additional tests (not in original list):

(1) PPD

 


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