Angina

Prolonged fever of unknown origin in children. Fever is prolonged

Fever of unknown origin (FUN)– a clinical diagnosis denoting a pathological condition, the main manifestation of which is a fever above 38°C, lasting 3 weeks or more, the cause of which cannot be determined after examination using generally accepted (routine) methods.

The main causes of LNG:

1. Infectious diseases– the cause of LNG in 30-50% of cases (most often it is tuberculosis, IE caused by slowly growing microorganisms or not confirmed by blood culture, purulent cholecystocholangitis, pyelonephritis, abdominal abscesses, septic thrombophlebitis of the pelvic veins, CMV infection, Epstein-Barr virus, primary HIV infection).

2. Oncological diseases– the cause of LNG in 20-30% of cases (most often these are lymphomas, leukemia, metastases of ovarian cancer)

3. Systemic connective tissue diseases– cause of LNG in 10-20% of cases (SLE, RA, intermittent arteritis, JRA in adults, vasculitis)

4. Other causes of LNG(drug fever, repeated pulmonary embolism, enteritis, sarcoidosis, feigned fever, etc.)

Currently, infectious diseases are the most common cause of LNE, the proportion of systemic vasculitis is the most common cause of LNE, the share of systemic connective tissue diseases has remained the same, and cancer has decreased. In 10% of adults, the cause of LNG remains unclear.

Principles for diagnosing LNG, applied after routine diagnostic methods have been performed:

1. Careful history and physical examination:

– a characteristic rash on the skin and mucous membranes may indicate IE

– increase in l. y., hepatomegaly requires their biopsy and histological examination

– an increase in the volume of the abdominal cavity may indicate the presence of intra-abdominal abscesses

– rectal and vaginal examination allows to exclude the presence of an abscess or inflammatory process of the pelvic organs

– cardiac examination allows to identify predisposing conditions for the development of IE

Dynamic monitoring of the appearance of new symptoms (increase in new groups of lymph nodes, the appearance of auscultatory signs of IE, rash, etc.) is mandatory.

Separately, one should remember about simulated fever, caused artificially by the patient himself. Its diagnosis should be considered in any case of LNG, especially in young women or those with medical training, when the condition is satisfactory, the temperature and pulse are inconsistent. If you suspect a feigned fever, you must pay attention to the absence of daily temperature fluctuations, carry out thermometry in the presence of a nurse or doctor, and use an electronic thermometer to immediately obtain results.

2. Laboratory research methods:

A) three blood samples for culture (preferably before AB use), urine and sputum culture

B) determination of the level of antibodies to EBV and CMV, especially the IgM class, in paired sera (one serum sample is taken in the acute phase of the disease, frozen and left for research, the second serum sample is taken 2-4 weeks after the first; the increase in titer has diagnostic significance AT 4 times or more); fever agglutinins are detected in agglutination tests with Salmonella spp., Brucella spp., Francisella tularensis and Proteus.

Possibilities for serological diagnosis of a number of infections:

– if fever lasts > 3 weeks, most viral infections can be excluded, with the exception of EBV and CMV

– toxoplasmosis – diagnosis is confirmed by detection of IgM during RIF

– rickettsioses – diagnosis is confirmed by agglutination tests with one or more Proteus vulgar antigens that cross-react with the main rickettsiae

– Q fever – detected by ELISA (most sensitive), RIF, RSK

– legionellosis – confirmed by culture isolation by direct fluorescence of bacteria in sputum, bronchial aspirate, pleural effusion or tissues.

– psittarkosis – diagnosed with a fourfold increase in AT titer in the RSC

C) study of antinuclear and other antibodies to identify collagenoses

D) study of ESR: often elevated in endocarditis, malignant neoplasms; with a very high ESR (> 100 mm/h) in the elderly, it is necessary to exclude arteritis of the temporal arteries (characterized by headaches, visual disturbances, myalgia, tense temporal arteries during palpation, the diagnosis is confirmed by a bilateral biopsy of the temporal arteries)

3. Instrumental research methods:

A) biopsy l. u. (performed with an increase in l.u. to exclude malignant and granulomatous diseases), liver (performed with hepatomegaly to identify granulomatous hepatitis), skin (nodules on the skin and rash can be observed in metastatic processes or vasculitis), arteries (to exclude arteritis of the temporal arteries etc.)

B) X-ray studies with contrast (excretory urography to identify hypernephroma, abscesses and renal tuberculosis, identify up to 93% of cases of renal tuberculosis, plain radiography of the abdominal organs to identify interintestinal abscesses, irrigoscopy, etc.)

C) radioisotope studies (scanning with isotopes of gallium, indium, etc.) to identify a number of tumors

D) Ultrasound: Echo-CG - detection of vegetations in IE, cardiac myxomas, ultrasound of the abdominal and pelvic organs - detection of abscesses and tumors, dissecting aneurysm of the abdominal aorta

E) CT is an effective and sensitive method for diagnosing abscesses of the brain, abdominal cavity and chest, MRI is used to diagnose toxoplasmosis encephalitis, purulent epiduritis and complex cases of osteomyelitis.

E) diagnostic laparoscopy - performed according to strict indications when clinical or laboratory-instrumental signs of disease of the abdominal organs are detected to clarify the diagnosis or for the purpose of treatment

Currently, detailed medical history collection, identification of laboratory markers of inflammation and signs and the use of direct visualization methods (ultrasound, CT, MRI) come to the fore in diagnosis; the relevance of radiopaque and isotope methods is decreasing.

4. Trial treatment- undertaken ONLY after a comprehensive examination, culture, in the presence of clinical and laboratory data indicating a probable cause of the disease, in the absence of a specific diagnosis (if TB is suspected - a 2-3 week course of anti-tuberculosis therapy with subsequent assessment of effectiveness, if TB is suspected IE - AB for health reasons, preferably penicillins + aminoglycosides, if LNG of tumor origin is suspected, the temperature is reduced with indomethacin, etc.)

Currently, it is customary to distinguish 4 main options for LNG:

1) “classic” version of LNG

2) LNG due to neutropenia

3) nosocomial LNG

4) LNG associated with HIV infection (microbacteriosis, CMV infection, cryptococcosis, histoplasmosis)

The main diseases of group 1, manifested by LNG:

1) infectious and inflammatory diseases

A) tuberculosis– one of the most common causes of LNG; the difficulty of diagnosis is due to the pathomorphosis of TB, the atypicality of the course, the increased frequency of various nonspecific manifestations (fever, articular syndrome, erythema nodosum, etc.), and frequent extrapulmonary localization; sometimes fever is the only sign of the disease, especially in miliary TB, disseminated TB with the presence of various extrapulmonary lesions (mesenteric lymph nodes, serous membranes, etc.); To make a diagnosis, a thorough examination of various biological materials (sputum, bronchoalveolar fluid, gastric lavage, cavity exudates, etc.), PCR, biopsy is necessary. u., liver (necessarily affected in hematogenously disseminated TB), etc., conducting trial tuberculostatic therapy (at least 2 drugs, one of which is isoniazid) with evaluation of the effect after 2-3 weeks

B) suppurative diseases of the abdominal cavity(abdominal and pelvic abscesses - subdiaphragmatic, subhepatic, intrahepatic, interintestinal, intraintestinal, tubo-ovarian, paranephric, prostate abscess, cholangitis, apostematous nephritis) - symptoms from the abdominal organs may be mild or completely absent (especially in the elderly); risk factors in the anamnesis (surgeries, abdominal trauma, intestinal diseases such as diverticulosis, UC, Crohn's disease), biliary tract (cholelethiasis, duct strictures), etc.; To verify the diagnosis, ultrasound, CT, diagnostic laparoscopy and laparatomy are used

B) IE– most often the basis of LNG is primary endocarditis in elderly patients; history of risk factors (drug addiction, heart defects, valve surgery); IE may be indicated by cerebrovascular accidents, recurrent pulmonary embolism, and the appearance of signs of heart failure; to verify the diagnosis - multiple microbiological blood tests, thorough echocardiography

D) osteomyelitis(usually in the spine, pelvic bones, feet) – febrile syndrome is often the only manifestation at the onset of the disease; landmarks suggesting osteomyelitis may include a history of skeletal injuries, sports, ballet, etc.; To verify the diagnosis, an X-ray examination of the relevant areas of the skeleton, CT scan, radioisotope bone scanning using 99Tc and other isotopes, bone biopsy are required

2) tumor diseases– taking into account the likelihood of a tumor of any localization in LNG, the oncological search should be aimed not only at the most vulnerable “tumor targets”, but also at other organs, especially considering the minimal local manifestations of the disease in the initial stages; a tumor may be indicated by a number of nonspecific symptoms (recurrent erythema, hypertrophic osteoarthropathy, migrating thrombophlebitis and other paraneoplastic manifestations); Oncological search in patients with LNG should include non-invasive examination methods (ultrasound, CT, MRI), radioisotope scanning of l. y., skeleton, abdominal organs, puncture biopsies, endoscopic methods, including laparoscopy, immunological research methods to identify some specific tumor markers (a-fetoprotein for primary liver cancer, CA 19–9 for pancreatic cancer, CEA for cancer colon, PSA for prostate cancer, etc.

3) systemic diseases– fever often precedes articular or systemic lesions; it is important to correctly assess all symptoms, even if they seem nonspecific and are associated with the fever itself (myalgia, muscle weakness, headache, etc. may indicate dermatomyositis, polymyalgia rheumatica, temporal arteritis, etc.); if there is a high probability of a systemic disease, a trial treatment of GCS in small doses (15–20 mg/day) is possible.

4) other diseases

A) thrombophlebitis of the deep veins of the extremities, pelvis, recurrent pulmonary embolism– history of recent childbirth, bone fractures, surgeries, MA, HF; fever is controlled with heparin within 48-72 hours

B) drug fevers(ABs, cytostatics, quinidine, carbamazepine, haloperidol, ibuprofen, allopurinol, etc.) – may occur at various intervals (days, weeks) after the drug is prescribed, disappears after discontinuation of the drug for several days

Since fever is a universal reaction to a variety of lesions in the body, any single unidirectional diagnostic search is impossible.

To conduct a qualified differential diagnosis in febrile patients, the therapist needs to know the clinical manifestations and features of the course of not only numerous diseases of internal organs, but also related pathologies, which are the competence of infectious disease specialists, oncologists, hematologists, phthisiatricians, neuropathologists and neurosurgeons. The difficulties are increased by the fact that there is no direct relationship between the height of the fever and objectively detectable data.

Anamnesis

At the first stage of the diagnostic search scheme, it is necessary to analyze the anamnestic information, conduct a thorough clinical examination of the patient and perform simple laboratory tests.

When collecting an anamnesis, attention is paid to profession, contacts, previous diseases, allergic reactions in the past, previous medications, vaccinations, etc. The nature of the fever is determined (temperature level, type of curve, chills).

Clinical examination

During the examination, the condition of the skin, mucous membranes, tonsils, lymph nodes, joints, venous and arterial systems, lungs, liver and spleen is analyzed. A thorough clinical examination helps to detect the affected organ or system, which should subsequently be used to search for the cause of the febrile syndrome.

Laboratory research

The simplest laboratory tests are performed: a general blood test with determination of the level of platelets and reticulocytes, a general urinalysis, total protein and protein fractions, blood sugar, bilirubin, AST, ALT, urea are examined.

To exclude typhoparatyphoid diseases and malaria, all febrile patients with an unclear diagnosis are prescribed a blood test for blood culture, Widal reaction, RSC, for malaria (thick drop), and antibodies to HIV.

An X-ray (not fluoroscopy!) of the chest organs is performed, and an ECG is taken.

If at this stage a pathology of any system or specific organ is identified, further search is carried out purposefully according to the optimal program. If fever is the only or leading syndrome and the diagnosis remains unclear, it is necessary to proceed to the next stage of the search.

A conversation should be held with a febrile patient so that when the body temperature rises, he does not panic and become a “slave of the thermometer.”

Consultations of narrow specialists

In case of monosymptomatic hyperthermia against the background of normal laboratory parameters, it is necessary to exclude: artificial hyperthermia, thyrotoxicosis and disorders of central thermoregulation. Low-grade fever can occur after a hard day at work, emotional stress and physical activity.

If there are changes in laboratory parameters, taking into account clinical manifestations, characteristics of the blood reaction, and the nature of the fever curve, appropriate specialists can be involved in the diagnostic process. If necessary, the patient can be consulted by an infectious disease specialist, gynecologist, hematologist, ENT doctor, oncologist and other specialists. However, examination of a patient by a specialist in order to clarify the diagnosis does not relieve the responsibility and need for a complete examination by the attending physician.

If the cause of the fever remains unclear, you need to move on to the next stage of the search. Taking into account the age, condition of the patient, the nature of the temperature curve and blood picture, the doctor must navigate the nature of the fever and classify it into one of the groups: infectious or somatic.

Diagnostic search for suspected infectious disease

In case of infectious fever (typhoparatyphoid infections and malaria were excluded at the previous stages of diagnosis), one should remember first of all the possibility of a tuberculous process due to the prevalence of the disease and the seriousness of the consequences of undiagnosed cases. The patient undergoes chest radiography and tomography, the Mantoux test, and repeated sputum culture for Koch's bacilli. In addition to lung lesions, tuberculosis of other localizations is possible.

If a bacterial infection is suspected, as evidenced by laboratory data (leukocytosis, neutrophilia with a shift to the left, toxic granularity of neutrophils), blood is cultured for sterility. Blood sampling for sterility and blood culture is not regulated by the time of day or food intake. Repeated sampling should be done (up to 5 during the day), especially during periods of rising body temperature.

From the second week of the disease, serological tests can be carried out. If necessary, duodenal intubation and culture of sputum, urine, feces and bile are performed.

Most often, infectious hyperthermia of unknown origin is observed in sepsis and primary infective endocarditis. It is especially dangerous to miss a meningococcal infection in a patient, which is accompanied by characteristic clinical symptoms.

If the viral nature of the disease is suspected, serological tests (RSC, RIGA, etc.) are indicated, if possible. The diagnostic increase in the titer of virus-neutralizing antibodies in paired sera provides a decoding of the diagnosis. However, the result of virological studies is ready no earlier than 10 days, when the clinical manifestations of the infection may disappear.

Epidemiological history

Epidemiological history is also important for identifying exotic (tropical) diseases that occur in the early stages with a febrile syndrome.

Diagnosis of sepsis

In case of hyperthermia, accompanied by dryness and a burning sensation in the oral cavity, hyperemia of the mucous membranes, and “sticking” in the corners of the lips, a study for fungal flora is necessary to exclude candidal sepsis in the patient.

Exclusion of a tumor process

In the case of prolonged fever without local data, the exclusion of sepsis and infective endocarditis, increased ESR and the presence of moderate anemia, we are almost always talking about a tumor process or diffuse connective tissue diseases.

Typically, somatic fevers occur against the background of weight loss, a distinct increase in ESR, and changes in other laboratory parameters.

To exclude diffuse connective tissue diseases, which in rare cases are monosymptomatic, a blood test is prescribed for rheumatoid factor, lupus cells, antibodies to DNA, antinuclear factor, and immunoglobulins. If necessary, a skin-muscle biopsy is performed. Additional information for the differential diagnosis of autoimmune and infectious fevers is provided by the NCT test. Its level is noticeably increased in infectious pathology.

If the tumor nature of hyperthermia is suspected, additional studies are carried out to exclude hemoblastoses (this includes lymphogranulomatosis) and malignant tumors. Detection of cytopenia or thrombocytopenia, M-gradient during serum protein electrophoresis, hemorrhagic syndrome and other clinical manifestations characteristic of hematological malignancies is an indication for trepanobiopsy or sternal puncture and myelogram examination. The presence of enlarged lymph nodes is an important argument in favor of performing a node biopsy. If the prerequisites exist, radiography of the mediastinum is indicated.

To exclude the diagnosis of malignant tumors, ultrasound examination of the abdominal organs and special x-ray examination methods (cholecystography, excretory urography, fluoroscopy of the stomach, irrigoscopy) are used. If necessary, endoscopic examination of the stomach and intestines and radioisotope scanning of the liver are performed. In some cases, angiographic examination of the abdominal organs or retroperitoneal space is performed.

To diagnose intra- and retroperitoneal formations, abscesses and enlarged lymph nodes of the abdominal cavity, gallium citrate scintigraphy is performed when possible. Currently, computed tomography is widely used to diagnose malignant tumors.

Diagnostic laparotomy

If all stages of the diagnostic search have been completed, but the cause of the febrile syndrome remains unclear, laparotomy is indicated. If there are doubts about the presence of a latent tuberculosis process in a patient at this stage of diagnosis, it is permissible to prescribe trial (testing) tuberculostatic therapy.

Occasionally there are situations when, despite conducting comprehensive research and using available methods, consultations with specialists, the cause of hyperthermia remains unclear. In such exceptional cases, the most probable diagnosis based on clinical and laboratory data is established and further monitoring of the patient is carried out over time. If new symptoms appear, a repeat or additional examination is carried out.

Absolute number of neutrophils ≤ 500 cells per mm 3

No diagnosis after three days of searching

HIV-associated

Temperature >38.3°C

Cytomegalovirus, Mycobacterial intracellular infection (specific infection of HIV-infected patients in the AIDS stage), pneumonia caused Pneumocystis carinii, drug-induced fever, Kaposi's sarcoma, lymphoma

Duration > 4 weeks for outpatients, > 3 days for inpatients

Confirmed HIV infection

Differential diagnosis of fever of unknown origin

The differential diagnosis of FUO typically falls into four main subgroups: infections, malignancies, autoimmune conditions, and others (see Table 2).

The main causes of fever of unknown origin. Table 2

Infections	Autoimmune diseases

Dental abscess
	Rheumatoid fever
Osteomyelitis	Inflammatory diseases colon

Cytomegalovirus
Epstein-Barr virus
Human immunodeficiency virus	Other
Lyme borreliosis	Drug-induced fever
Prostatitis	Complications of cirrhosis
	Fake fever
Malignant tumors	Family history should be examined to identify hereditary causes of fever, such as familial Mediterranean fever. You should also find out if among the immediate family there are patients suffering from lymphoma, rheumatism and chronic inflammatory diseases of the large intestine (Crohn's disease, ulcerative colitis). In patients taking medications, drug-induced fever should be excluded, although it is a relatively rare cause of FUO. Many diagnostic clues can be easily missed during the first examination, but may become apparent with repeated examinations, so repeat visits are warranted. During the physical examination, special attention should be paid to the condition of the skin, mucous membranes and lymphatic system, as well as palpation of the abdomen for tumors or enlarged organs. The need to use imaging techniques (radiography, ultrasound, MRI, etc.) should be justified by clinical suspicion of specific diseases, and not simply prescribe studies to the patient according to any list (for example, cardiac murmur, increasing in dynamics, even against the background of negative blood cultures for sterility - this is a reason to perform transthoracic echocardiography or, if necessary, transesophageal echocardiography). Initial methods of additional examination provide the basis for further differential diagnosis Ultrasound of the abdominal cavity and pelvic organs - according to indications. Simple "symptom clues" found during initial testing often allow the clinician to lean toward one of the larger FUO groups and focus and optimize efforts. Further diagnostic studies should be a logical continuation of the emerging diagnostic hypotheses; One should not slip into haphazardly prescribing expensive and/or invasive methods. Skin test with tuberculin - inexpensive a screening test that should be prescribed to all patients with fever of unknown origin. However, this method alone cannot be a sufficient substantiation of the tuberculous etiology of fever, or the presence of active tuberculosis. A chest radiograph should also be obtained in all such patients to identify possible infection, collagen vascular disease, or malignancy. If the x-ray does not provide the necessary information, and the suspicion of these diseases remains, it is possible to prescribe more specific research methods: serological, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) and isotope scanning. Ultrasound of the abdominal cavity and pelvic organs, as well as CT, can be prescribed at the first stage of diagnosis if there is a strong suspicion of diseases of the organs of these cavities. These methods, coupled with targeted biopsies, significantly reduce the need for invasive techniques (laparoscopy, biopsy, etc.) MRI should be deferred to later stages and used only when it is necessary or the diagnosis remains unclear. The use of radionucleotide methods is justified in some inflammatory or tumor diseases, but is completely useless in collagen vascular diseases and other diseases. Endoscopic techniques may be useful in diagnosing certain diseases, such as inflammatory bowel disease and sarcoidosis. The newest diagnostic method in evaluating a patient with FUO is positron emission tomography (PET). This method is of very high value in identifying the inflammatory causes of fever, but is not available everywhere. More invasive testing, such as lumbar puncture, bone marrow, liver, or lymph node biopsies, should be performed only when clinical signs and initial examinations indicate the presence of relevant pathology, or if the source of fever remains unknown after the most thorough examination.

Sometimes there are cases when the patient’s body temperature rises (more than 38 ° C) against the background of almost complete health. This condition may be the only sign of the disease, and numerous studies do not allow us to determine any pathology in the body. In this situation, the doctor, as a rule, makes a diagnosis of fever of unknown origin, and after that prescribes a more detailed examination of the body.

ICD 10 code

Fever of unknown etiology R50 (except for childbirth and puerperal fever, as well as fever of newborns).

R 50.0 – fever accompanied by chills.
R 50.1 – persistent fever.
R 50.9 – unstable fever.

ICD-10 code

R50 Fever of unknown origin

Symptoms of fever of unknown origin

The main (often the only) sign of fever of unknown origin is considered to be an increase in temperature. Over a long period, an increase in temperature can be observed without accompanying symptoms, or occur with chills, increased sweating, cardiac pain, and shortness of breath.

There is definitely an increase in temperature values.
The type of fever and temperature characteristics, as a rule, do little to reveal the picture of the disease.
There may be other signs that usually accompany an increase in temperature (headache, drowsiness, body aches, etc.).

Temperature readings may vary depending on the type of fever:

low-grade fever (37-37.9°C);
febrile (38-38.9°C);
pyretic (39-40.9°C);
hyperpyretic (41°C >).

Prolonged fever of unknown origin can be:

acute (up to 2 weeks);
subacute (up to one and a half months);
chronic (more than one and a half months).

Fever of unknown origin in children

Fever in a child is the most common problem with which people consult a pediatrician. But what temperature in children should be considered a fever?

Doctors differentiate a fever from just a high temperature when the readings exceed 38°C in infants and above 38.6°C in older children.

In most young patients, fever is associated with a viral infection; a smaller percentage of children suffer from inflammatory diseases. Often such inflammations affect the urinary system, or latent bacteremia is observed, which can later be complicated by sepsis and meningitis.

The most common causative agents of microbial infections in childhood are the following bacteria:

streptococci;
gram (-) enterobacteria;
listeria;
hemophilus influenzae infection;
staphylococci;
salmonella.

Diagnosis of fever of unknown origin

According to the results of laboratory tests:

general blood test - changes in the number of leukocytes (with a purulent infection - a shift in the leukocyte formula to the left, with a viral infection - lymphocytosis), acceleration of ESR, change in the number of platelets;
general urinalysis - leukocytes in the urine;
blood biochemistry - increased levels of CRP, increased levels of ALT, AST (liver disease), fibrinogen D-dimer (PE);
blood culture - demonstrates the possibility of bacteremia or septicemia;
urine culture - to exclude the renal form of tuberculosis;
bacterial culture of bronchial mucus or feces (according to indications);
bacterioscopy – if malaria is suspected;
diagnostic complex for tuberculosis infection;
serological reactions - if syphilis, hepatitis, coccidioidomycosis, amoebiasis, etc. are suspected;
AIDS test;
thyroid examination;
examination for suspected systemic connective tissue diseases.

According to the results of instrumental studies:

radiograph;
tomographic studies;
skeletal system scan;
ultrasound examination;
echocardiography;
colonoscopy;
electrocardiography;
bone marrow puncture;
biopsy of lymph nodes, muscle or liver tissue.

An algorithm for diagnosing fever of unknown origin is developed by the doctor on an individual basis. To do this, the patient is determined to have at least one additional clinical or laboratory symptom. This could be a disease of the joints, a low level of hemoglobin, enlarged lymph nodes, etc. The more such auxiliary signs are discovered, the easier it will be to establish the correct diagnosis, narrowing the range of suspected pathologies and determining targeted diagnostics.

Differential diagnosis of fever of unknown origin

Differential diagnosis is usually divided into several main subgroups:

infectious diseases;
oncology;
autoimmune pathologies;
other diseases.

When differentiating, attention is paid not only to the patient’s symptoms and complaints at the moment, but also to those that existed before but have already disappeared.

It is necessary to take into account all diseases that preceded the fever, including surgical interventions, injuries, and psycho-emotional states.

It is important to clarify hereditary characteristics, the possibility of taking any medications, the subtleties of the profession, recent travel, information about sexual partners, and about animals present at home.

At the very beginning of the diagnosis, it is necessary to exclude the intentionality of the febrile syndrome - cases of the intended administration of pyrogenic drugs or manipulations with a thermometer are not so rare.

Skin rashes, heart problems, enlarged and painful lymph nodes, and signs of fundus disorders are of great importance.

Treatment of fever of unknown origin

Experts do not advise blindly prescribing drugs for fever of unknown origin. Many doctors rush to use antibiotic therapy or corticosteroid treatment, which can blur the clinical picture and complicate further reliable diagnosis of the disease.

Regardless, most doctors agree that it is important to determine the causes of a fever using all possible methods. Until the cause is established, symptomatic therapy should be carried out.

As a rule, the patient is hospitalized, sometimes isolated if an infectious disease is suspected.

Drug treatment can be prescribed taking into account the detected underlying disease. If such a disease is not detected (which happens in approximately 20% of patients), then the following medications may be prescribed:

antipyretic medications - non-steroidal anti-inflammatory drugs (taking indomethacin 150 mg per day or naproxen 0.4 mg per day), paracetamol;
the initial stage of taking antibiotics is the penicillin series (gentamicin 2 mg/kg three times a day, ceftazidime 2 g intravenously 2-3 times a day, azlin (azlocillin) 4 g up to 4 times a day);
if antibiotics do not help, start taking stronger drugs - cefazolin 1 g intravenously 3-4 times a day;
amphotericin B 0.7 mg/kg per day, or fluconazole 400 mg per day intravenously.

Treatment is continued until the general condition is completely normalized and the blood picture is stabilized.

Prevention of fever of unknown origin

Preventive measures consist of early detection of diseases that may later cause an increase in temperature. Of course, it is equally important to competently treat detected pathologies, based on the doctor’s recommendations. This will avoid many adverse effects and complications, including fever of unknown origin.

What other rules must be followed to avoid diseases?

Contact with carriers and sources of infection should be avoided.
It is important to strengthen the immune system, increase the body's resistance, eat well, consume enough vitamins, remember to be physically active and follow the rules of personal hygiene.
In some cases, specific prevention may be used in the form of vaccinations and inoculations.
It is advisable to have a permanent sexual partner, and in case of casual relationships, barrier methods of contraception should be used.
When traveling to other countries, you must avoid eating unknown foods, strictly observe personal hygiene rules, do not drink raw water and do not eat unwashed fruits.