Fever of unknown origin: keys to determining the etiology in older patients.
In light of improvements in imaging modalities and laboratory tests, fewer cases of fever of unknown origin (FUO) are being attributed to infectious causes and more are eventually being diagnosed as secondary to noninfectious causes, particularly tumors and connective tissue diseases. Older patients with FUO usually present with mild, nonspecific, normochromic, and normocytic anemia and an elevated erythrocyte sedimentation rate. The history, physical examination, and imaging studies are key to making a diagnosis. Although the results of laboratory tests are generally nonspecific, such tests are appropriate nonetheless. Obtaining repeat blood cultures is mandatory. However, before undertaking a diagnostic evaluation of geriatric FUO, it is important to consider the patient's overall health. In certain circumstances, it is more important to maintain a patient's quality of life than it is to initiate the process of identifying and treating a persistent fever. The work-up and treatment should not be worse than the disease.
Woolery
Wm Alan
WA
Department of family and community medicine, Mercer University School of Medicine, Macon, GA, USA.
Franco
Fabian R
FR
D000368:Aged; D000465:Algorithms; D064420:Drug-Related Side Effects and Adverse Reactions; D004697:Endocarditis, Bacterial / Q000150:complications; D005335:Fever of Unknown Origin / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D005853:Geriatrics; D006801:Humans; D008223:Lymphoma / Q000150:complications; D009369:Neoplasms / Q000150:complications; D012189:Retrospective Studies