Differential Diagnosis of Fever of Unknown Origin

Differential Diagnosis of Fever of Unknown Origin: 1. Infection: 30% - Bacterial. Viral. Fungal. Protozoal. Sepsis 2. Malignancy: 20% - Acute Leukemia. Lymphoma. Hepatic Tumors. Renal Tumors. Gastric Tumors. Pancreatic Tumors. Bacterial Infection Viral Infection Fungal Infection Protozoal Infestation 1 3. Connective Tissue Diseases: 15% - Rheumatoid Arthritis. SLE. Giant Cell Arthritis. Polyarthritis Nodosa. Polymyositis. Vasculitis. 4. Others: 20% - Crohn’s Disease. - Sarcoidosis. - Myocardial Infarction. - Atrial Myxoma. - Pulmonary Embolism. - Liver Cirrhosis. - Thyrotoxicosis. - Drug Interaction. - Mediterranean Fever. - Post Immunization. - Sun Stroke 1. Sub-Acute Bacterial Infective Endocarditis. 2. Tuberculosis (TB). 3. Typhoid Fever. 4. Brucellosis. 5. Q-Fever. 6. Rickettsia (Rocky Mountain Spotted Fever). 1. Influenza. 2. Glandular Fever (Infectious Mononucleosis). 3. Human Immunodeficiency Virus (HIV). 4. Cyto-Megalo-Virus (CMV). 5. Ebstein-Barr Virus (EBV) 1. Candidiasis. 2. Aspergillosis. 3. Pneumocystic Jeroveci (Carinii). 1. Malaria. 2. Amoebiasis. 3. Toxoplasmosis. DR. MOHCEN AL. HAJ FEVER as Main Complain: INTRODUCE YOUR SELF & TAKE PERMISSION FROM THE PATIENT. 1. PERSONAL DATA: Name, Age, Gender, Nationality, Occupations. 2. MAIN COMPLAIN: What is Your Complain? & Duration. 3. ANALYSIS OF MAIN COMPLAIN:Character of FEVER + DOARA CS Character of Fever  Measured OR Not & How it Was? Continuous OR Intermittent? D Duration Acute Chronic O Onset Sudden Gradual A  Aggravating Factors R  Relieving Factors A  Associated Symptoms + Systemic Review In Case of  Bacterial Infection: 1. Sub-Acute Bacterial Infective Endocarditis Ask About: Anorexia, Weight Loss, Vomiting, Right Upper Abdominal Pain, Malaise, Headache, Myalgia, Arthralgia, Lambo-Sacral Back Pain, Night Sweating, Cough, Dyspnea, Chest Pain. Also Ask About Emboli Complication of Infective Endocarditisas as: Headache, Neck Stiffness & Photophobia For Meningitis. Hemipariesis & Slurred Speech For Stroke. Painless Hematuria For Kidney Infarction & Renal Failure. Sudden Onset Dyspnea & Chest Pain For Pulmonary Embolism. 2. Tuberculosis Ask About: Anorexia, Weight Loss, Dyspnea, Cough, Hemoptysis, Chest Pain, Night Sweating, Fatigue, Myalgia, Arthralgia For  Pulmonary TB. Mental status Change Progress to Coma For  TB Meningitis. Back Pain & Stiffness, Lower Extremity Paralysis, Joint Pain For  Skeletal TB. Loin Pain, Dysuria, Frequent Urination, Painful Scrotal Mass ForGenitourinary TB Oral Ulcer, Dysphagia, Abdominal Pain, Diarrhea, Steatorrhea, Hematochezia For  Gastrointestinal TB. 2 DR. MOHCEN AL. HAJ 3. Typhoid Fever Ask About: *At First Week  Headache, Myalgia, Abdominal Pain, Constipation (Diarrhea & Vomiting in Children), *At Second Week  Maculo-Papular Rash on Trunk (Rose Spots), Cough, Abdominal Distention, Splenomegaly, Diarrhea, Bradycardia, Epistaxis, Leukopenia, Hyponatraemia *At Third Week  Anorexia, Significant Weight Loss, Abdominal Distention, Foul Yellow Green Diarrhea (Pea Soup Diarrhea) Tachypnea, Delirium, Confusion, Coma, Toxemia, Death. 4. Brucellosis Ask About: Anorexia, Weight Loss, Abdominal Pain, Constipation, Fatigue, Sweating, Weakness, Dizziness, Joint &, Muscle Pain, Low Back Pain Due to Sacro-Illitis. Scrotal Pain, Headache, Depression, Delirium, Cough, Dyspnea, Pleuritic Chest Pain. 5. Q Fever Ask About: Headache, Myalgia, Chills, Sweating, Dry Cough, Dyspnea, Pluritic Chest Pain, Nausea, Vomiting, Diarrhea. Abdominal Pain, Erythema Nodosum, Maculopapular Rash with Priritis. 6. Rickettsia Ask About: Headache, Rash, Confusion, Delirium, Myalgia, Abdominal Pain, Diarrhea. 1. Influenza In Case of  Ask About: Viral Infection: Anorexia, Headache, Malaise, Nasal Discharge, Sore Throat, Cough, Weakness, Severe Fatigue, Myalgia. 2. Glandular Fever Ask About: Headache, Anorexia, Malaise, Earache, Periorbital Edema, Fatigue, Chills, Pharyngitis, Sore Throat, Enlarged Tonsils, Palate Petechial Heamorrhage, Splenomegaly, Lymphadenopathy (Especially Posterior Cervical. Axillary & Inguinal Lymph Node), Maculo-Papular Skin Rash If Treated By Ampicillin 3. Human Immunodeficiency Virus (HIV) Ask About: *After 2 – 6 Weeks  Fatigue, Generalized Skin Rash, Headache,Malaise, Myalgia, Arthralgia, Mucosal Ulceration, Cervical Lymphadenopathy *After 7 – 10 Years  COLD WINTRPHL C= Candidiasis (Oro-Pharyngeal & Vaginal), O= Oral Trush, L= Leukoplakia, D= Diarrhea, W= Weight Loss, I= Idiopathic Thrombocytopenic Purpura, N= Night Sweating, T= Tinea Corporis, R= Recurrent Pelvic Inflammatory Disease, P= Peripheral Neuropathy, H= Herpes Zoster, L= Low Grade Fever. 3 DR. MOHCEN AL. HAJ 4. Cyto-Megalo-Virus (CMV) & Ebstein-Barr Virus (EBV) Ask About: Headache, Anorexia, Malaise, Pharyngitis, Sore Throat, Weakness, Severe Fatigue, Myalgia, Enlarged Tonsils, Cough, Dyspnea, Splenomrgaly, Abdominal Pain, Diarrhea, Maculo-Papular Skin Rash. In Case of  Ask About: 1. Candidiasis Fungal Infection: Skin Rash, Paronychia, Pruritis Especially in Genitocrural Fold, Anal Regions, Axilla For  Cutaneous Candidiasis. Painful Mouth, Burning Mouth OR Tongue, Whitish Thick Patch on Mucous Membrane,Sore Through, Dysphagia For  Oropharyngeal Candidiasis. Dysphagia, Odynophagia, Retrosternal Pain, Epigastric Pain, Nausea, Voimiting For  Esophageal Candidiasis. Vaginal Pruritis & Discharge, Dysuria & Dyspareunia For  Genital Candidiasis. 2. Aspergillosis Ask About: Productive Cough with Mucus Plugs, Hemoptysis, Dyspnea, Pleuritic Chest Pain, Night Sweating, Weight Loss. 3. Pneumocystic Jiroveci (Carinii) Ask About: Dry Cough, Dyspnea, Crepitation in Immune-Compromised Patient. 1. Malaria In Case of  Ask About: Protozoal Infection: Anorexia, Headache, Malaise, Photophobia, Myalgia, Artharlgia, Cough, Nausea, Vomiting, Jaundice & Mild Diarrhea (Features of Hemolytic Anemia), Palpitation, Dizziness, Fatigue, Hepatosplenomegaly, Confusion, Convulsion, Coma (Due to Cerebral Malaria). 2. Amoebiasis Ask About: Abdominal Pain, Cramps & Tenderness, Frequent Offensive Diarrhea & Tenesmus (Dysentery) Mixed with Blood & Mucus, Also Extra-Intestinal Amebiasis Resulting in Liver Abscess, Brain Abscess Lung Abscess 3. Toxoplasmosis Ask About: Cervical Lymphadenopathy, Malaise, Night Sweating, Mayalgia, Abdominal Pain, Seizures, Hemipariesis, Wrakness, Cerebellar Signs, Movement Disorders, Altered Mental State, Headache For  CNS Toxoplasmosis. Cough, Dyspnea, Chest Discomfort For  Toxoplasmotic Pneumonitis. 4 DR. MOHCEN AL. HAJ In Case of  Acute Leukemia: Fatigue, Dizziness, Palpitation, Dyspnea on Mild Exertion, Skin Bruises, Bleeding Tendency, Palpable Lymphadenopathy, Splenomegaly, Leukopenia. In Case of  Lymphoma: Lymphadenopathy, Night Sweating, Weight Loss, Cough, Dyspnea, Chest Pain, Abdominal Pain & Distension, Bone Pain, Pallor, Purpura, Echymosis, Thyroid Mass, Testicular Mass. In Case of  Other Malignancies: Significant Weight Loss, Cachexia, Abdominal Distension, Jaundice, Lymphadenopathy, Bone Pain, Back Pain. Headache, Blurred Vision, Projectile Vomiting, Cough, Dyspnea, Hemoptysis. In Case of  Connective Tissue Diseases: Joint Pain, Reynaud’s Phenomena, Morning Stiffness More than 1 Hour For  Rheumatoid Arthritis, Joint Pain, Reynaud’s Phenomena, Hair Loss, Discoid Lupus, Photosensitivity For  SLE. Unilateral Painless Blurred Vision, Vision Loss, Diplopia, Neck & Shoulder Pain, Jaw Claudication, Scalp Tenderness, Fever, ,Fatigue, Anorexia, Malaise, Difficulty to Open the Mouth  Giant Cell Arthritis. In Case of  Crhon’s Disease: Oral Ulcer, Diarrhea, Steatorrhea, Weight Loss, Per-Anal Disease (Fistula. Hemorrhoids), Jaundice, Red Eye, Arthralgia, Back Pain, Erythema Nodosum. In Case of  Sarcoidosis: Anorexia, Arthralgia, Cough, Hemoptysis, Dyspnea, Chest Pain, Lymphadenopathy. In Case of  Myocardial Infarction: Sudden Onset Chest Pain Radiating to Left Arm, Dyspnea, Sweating, Vomiting. In Case of  Pulmonary Embolism: Sudden Onset Chest Pain, Dyspnea, Cough, Heamoptysis, Evidence of DVT. In Case of  Liver Cirrhosis: Jaundice, Abdominal Distension, Lower Limb Edema, Bleeding Tendency. In Case of  Thyrotoxicosis: Palpitation, Tremor, Neck Swelling (Goiter), Sweating, Heat Intolerance, Diarrhea, Insomnia, Anxiety, Nervousness. 5 DR. MOHCEN AL. HAJ C Coarse Regressive or Constant or Progressive. S Severity Interfering with Daily Activity. Interfering with Sleep. 5. PAST MEDICAL HISTORY: *History of Same Illness Before? If Yes How Many Times? When Was the Last Time? Does He Admitted or No? Does He Admitted to ICU or No? What are the Investigations? *History of Any Chronic Illness (Like DM, HTN, CTD, CKD, Epilepsy, Respiratory Diseases,)? If Yes  What is the Duration of the Chronic Illness? What is the Treatment? Does He in Regular Follow up? History of Vaccination? *History of Any Auto-Immune Disease  Like DM type I, Vitiligo, Thyroid Diseases. *Ask About Viral Screen. 6. PAST SURGICAL HISTORY: *Any History of Surgery. *Any Tattoo Marking  FOR Hepatitis. *Any History of Blood Transfusion  FOR Hepatitis. *Any History of Heamodialysis  FOR CKD & Hepatitis. 7. DRUG HISTORY: *Also If Patient Has Any Chronic Illness That Means He Has Drug History Such as  NSAIDS, Methotrexate, Gold, Warfarin (FOR Anti-Phospholipid Syndrome). 8. FAMILY HISTORY: *Any History of Same Illness in Her Family. *Ask if Her First Relative Degrees Had Any Chronic Illness (Like DM, HTN). 9. SOCIAL HISTORY: *Ask *Ask *Ask *Ask If He is Smoker or Ex-Smoker (If He is Smoker Ask about Duration & Amount). If He is Alcoholic (If He is Alcoholic Ask about Duration & Amount). Where He Lives In a Farm - House (For Insects OR Skin Infection). About Drug Addiction (For Hepatitis). 10. TRAVIL HISTORY: *For  Any Infection (Especially Malaria). 11. SEXUAL HISTORY: *For  HIV & Hepatitis, Also For Sexual Transmitted Diseases. 12. NUTRITIONAL HISTORY: *For  Food Posoning. 6 DR. MOHCEN AL. HAJ