Managing fever of unknown origin in adults - BMJ review

Few clinical problems generate such a wide differential diagnosis as pyrexia (fever) of unknown origin. The initial definition proposed by Petersdorf and Beeson in 1961 was later revised. Essentially the term refers to a prolonged febrile illness without an obvious cause despite reasonable evaluation and diagnostic testing.

Definition

Classic adult fever of unknown origin (FUO) is fever of 38.3°C (101°F) or greater for at least 3 weeks with no identified cause after 3 days of hospital evaluation or 3 outpatient visits

Causes of FUO

Common causes of FUO are infections, neoplasms, and connective tissue disorders.

Investigations almost always include imaging studies. Serological tests may be indicated

Treatment of FUO

Empirical antibiotics are warranted only for individuals who are clinically unstable or neutropenic. In stable patients empirical treatment is discouraged, although NSAIDs may be used after investigations are complete. Empirical corticosteroid therapy is discouraged.

References:

Investigating and managing pyrexia of unknown origin in adults. BMJ 2010; 341:c5470 doi: 10.1136/bmj.c5470 (Published 15 October 2010).

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'Nodding disease' - Sudan and Uganda's incurable child disease with unknown cause

AlJazeeraEnglish: Hundreds of children in southern Sudan have died from a mysterious illness that they have called the "nodding disease". The mentally and physically disabling disease, which has no cure yet and affects only children, first emerged in Sudan in 1980s.

"We have no clue as what is causing this. It's like a detective novel and a murder mystery, because it's fatal," says a tropical disease specialist from UNICEF.

Bizarrely, the seizures occur when the sufferers start to eat, or when it is particularly cold. When a bowl of sorghum is placed in front of Susannah, the "nodding" begins almost immediately, and stop when she has finished eating.

Some villagers say the disease is a curse, others blame the country's long civil war and suspect that government forces have been dropping chemical weapons.

93% of those surveyed are infected with a parasitic worm which causes Onchocerciasis (also known as river blindness). However, the level of infection among children without "nodding" is 63%. The worm is carried by black flies which breed near fast-flowing rivers.



A team of CDC experts conducts a multifaceted investigation in northern Uganda. An Epidemic Intelligence Service Officer tells the story about Nodding Disease, a neurologic syndrome which is devastating to afflicted children.

References:

'Nodding disease' hits Sudan. BBC, 2003.

African outbreak stumps experts: childhood nodding syndrome. Nature, 2011.
Mysterious nodding disease debilitates children - CNN, 2012.