Feverish states of unknown etiology. Increased body temperature in children with developmental disabilities: available methods and drugs

Fever of unknown origin - the main symptoms:

Headache
mood swings
Weakness
Lower back pain
Joint pain
Dizziness
Elevated temperature
Nausea
Cardiopalmus
Loss of appetite
Vomit
Chills
Lack of air
Heartache
Muscle pain
Increased sweating
Pale skin
intense thirst
Feeling broken
stool disorder

Fever of unknown origin and syn. LNG is a clinical case in which elevated body temperature is the leading or only clinical sign. This state is said when the values persist for 3 weeks (in children - longer than 8 days) or more.

Possible reasons could be oncological processes, systemic and hereditary pathologies, drug overdose,.

Clinical manifestations often limited to raising the temperature to 38 degrees. This condition may be accompanied by chills, increased sweating, breathlessness and pain different localization.

object diagnostic search is the root cause, so the patient is required to undergo a wide range laboratory and instrumental procedures. Primary diagnostic measures are required.

The therapy algorithm is selected individually. With a stable condition of the patient, treatment is not required at all. In severe cases, a trial regimen is used, depending on the alleged pathological provocateur.

According to the international classification of diseases of the tenth revision, fever of unknown origin has its own code. The ICD-10 code is R50.

Causes of the disease

A feverish condition that lasts no more than 1 week indicates an infection. It is assumed that prolonged fever is associated with the course of any serious pathology.

Fever of unknown origin in children or adults may be the result of an overdose of drugs:

antimicrobial agents;
antibiotics;
sulfonamides;
nitrofurans;
anti-inflammatory drugs;
which are prescribed for diseases of the gastrointestinal tract;
cardiovascular drugs;
cytostatics;
antihistamines;
iodine preparations;
substances that affect the CNS.

The medicinal nature is not confirmed in those cases when, within 1 week after discontinuation of the drug, the temperature values \u200b\u200bremain high.

Causes of fever of unknown origin

Classification

Based on the nature of the course, fever of unknown origin is:

classical - against the background of pathologies known to science;
nosocomial - occurs in persons who are in the intensive care unit for more than 2 days;
neutropenic - there is a decrease in the number of neutrophils in the blood;
HIV-associated.

According to the level of temperature increase in LNG, it happens:

subfebrile - varies from 37.2 to 37.9 degrees;
febrile - is 38–38.9 degrees;
pyretic - from 39 to 40.9;
hyperpyretic - above 41 degrees.

According to the type of changes in values, the following types of hyperthermia are distinguished:

constant - daily fluctuations do not exceed 1 degree;
relaxing - variability throughout the day is 1-2 degrees;
intermittent - there is an alternation normal state with pathological, the duration is 1-3 days;
hectic - noted jumps temperature indicators;
wavy - the thermometer indicators gradually decrease, after which they increase again;
perverted - indicators are higher in the morning than in the evening;
wrong - has no patterns.

The duration of a fever of unknown origin can be:

acute - lasts no longer than 15 days;
subacute - the interval is from 16 to 45 days;
chronic - more than 1.5 months.

Symptoms of the disease

The main, and in some cases the only, symptom of a fever of unknown origin is an increase in body temperature.

The peculiarity of this condition is that the pathology for a rather long period of time can proceed completely asymptomatically or with erased symptoms.

Main additional manifestations:

muscle and joint pain;
dizziness;
feeling short of breath;
increased heart rate;
chills;
increased sweating;
pain in the heart, in the lower back or in the head;
lack of appetite;
stool disorder;
nausea and vomiting;
weakness and weakness;
frequent mood swings;
strong thirst;
drowsiness;
pallor of the skin;
decrease in performance.

External signs occur in both adults and children. However, in the second category of patients, the severity accompanying symptoms may be much higher.

Diagnostics

Diagnosis of fever of unknown origin

To identify the cause of fever of unknown origin, a comprehensive examination of patients is required. Before the implementation of laboratory and instrumental studies, primary diagnostic measures are necessary, carried out by a pulmonologist.

The first step in establishing a correct diagnosis includes:

study of the medical history - to search for chronic diseases;
collection and analysis of life history;
a thorough physical examination of the patient;
listening to a person with a phonendoscope;
measurement of temperature values;
a detailed survey of the patient for the first time of occurrence of the main symptom and the severity of concomitant external manifestations and hyperthermia.

Laboratory research:

general clinical and biochemical blood tests;
microscopic examination of feces;
general analysis of urine;
bacterial culture of all human biological fluids;
hormonal and immunological tests;
bacterioscopy;
serological reactions;
PCR tests;
Mantoux test;
AIDS tests and.

Instrumental diagnostics fever of unknown origin involves the implementation of such procedures:

radiography;
CT and MRI;
scanning of the skeletal system;
ultrasonography;
ECG and echocardiography;
colonoscopy;
puncture and biopsy;
scintigraphy;
densitometry;
EFGDS;
MSCT.

Densitometry

Need expert advice from various areas medicine, for example, gastroenterology, neurology, gynecology, pediatrics, endocrinology, etc. Depending on which doctor the patient gets to, they can be prescribed additional procedures diagnosis.

The differential diagnosis is divided into the following main subgroups:

infectious and viral diseases;
oncology;
autoimmune diseases;
systemic disorders;
other pathologies.

Treatment of the disease

When a person's condition is stable, experts recommend refraining from treating fever of unknown origin in children and adults.

In all other situations, trial therapy is performed, the essence of which will differ depending on the alleged provocateur:

with tuberculosis, anti-tuberculosis substances are prescribed;
infections are treated with antibiotics;
viral diseases are eliminated with the help of immunostimulants;
autoimmune processes - a direct indication for the use of glucocorticoids;
for diseases of the gastrointestinal tract, in addition to medicines, diet therapy is prescribed;
when malignant tumors are detected surgical intervention, chemotherapy and radiotherapy.

If medicinal LNG is suspected, the medications taken by the patient should be discontinued.

As for the treatment of folk remedies, it must be agreed with the attending physician - if this is not done, the possibility of aggravating the problem is not excluded, the risk of complications increases.

Prevention and prognosis

To reduce the likelihood of developing a pathological condition, it is necessary to adhere to preventive recommendations aimed at preventing the occurrence of a possible disease provocateur.

Prevention:

conducting healthy lifestyle life;
complete and balanced nutrition;
avoiding the influence of stressful situations;
prevention of any injury;
permanent strengthening of the immune system;
taking medications in accordance with the recommendations of the clinician who prescribed them;
early diagnosis and complete treatment any pathologies;
regular passage of preventive examination V medical institution with a visit to all specialists.

Fever of unknown origin has an ambiguous prognosis, which depends on the underlying cause. The complete absence of therapy is fraught with the development of complications of one or another underlying disease, which often ends in death.

Fever of unknown origin - symptoms and treatment, photos and videos

What to do?

If you think that you have Fever of unknown origin and symptoms characteristic of this disease, then doctors can help you: a pulmonologist, a therapist, a pediatrician.

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If, in the absence of other painful symptoms the temperature suddenly rises and persists for a long period, there is a suspicion that this is a fever of unknown origin (FUN). It can occur in both adults and children in the presence of other diseases.

Causes of fever

In fact, fever is nothing more than a protective function of the body, which “turns on” in the fight against active bacteria or other pathogens. In simple terms, due to the increase in temperature, they are destroyed. Related to this is the recommendation not to lower the temperature with pills if it does not exceed 38 degrees, in order to enable the body to cope with the problem on its own.
Typical causes of LNG are severe systemic infectious diseases:

tuberculosis;
salmonella infection;
brucellosis;
borreliosis;
tularemia;
syphilis (see also -);
leptospirosis;
malaria;
toxoplasma;
AIDS;
sepsis.

Among the localized diseases that cause fever are:

blood clots;
abscess;
hepatitis;
damage to the genitourinary system;
osteomyelitis;
dental infections.

Fever symptoms

The main symptom of this disease is fever body, which can last up to 14 days. Along with this, symptoms characteristic of patients of any age appear:

lack of appetite;
weakness, fatigue;
increased sweating;
chills;

These symptoms are of a general nature, they are inherent in most other diseases. Therefore, it is necessary to pay attention to such nuances as the presence of chronic diseases, reactions to medications, contacts with animals.

Symptoms "pink" And "pale" fevers differ in clinical features. At the first type of fever in an adult or child, the skin is normal in color, slightly moist and warm - this condition is considered not very dangerous and easily passes. If the skin is dry, vomiting, shortness of breath and diarrhea appear, you should sound the alarm to prevent excessive dehydration of the body.

"Pale" fever is accompanied by marbled pallor and dryness of the skin, blue lips. The limbs of the arms and legs also become cold, there are interruptions in the heartbeat. Such signs indicate a severe form of the disease and require immediate medical attention.

When the body does not respond to antipyretics, and the body temperature goes off scale, there may be a violation of the function of important organs. Scientifically, this condition is called hyperthermic syndrome.

With a "pale" fever, urgent comprehensive medical care is needed, otherwise irreversible processes may begin, which sometimes lead to death.

If a newborn has a fever of more than 38 degrees, and in a child older than one year - 38.6 and above, you should immediately consult a doctor. The same must be done if an adult has a fever of up to 40 degrees.

Disease classification

In the course of the study, medical researchers identified two main types of LNG: infectious And non-infectious.

The first type is characterized by the following factors:

immune (allergies, diseases connective tissue);
central (problems with the central nervous system);
psychogenic (neurotic and psychophysical disorders);
reflex (sensation of severe pain);
endocrine (metabolic disorders);
resorption (incision, bruise, tissue necrosis);
medication;
hereditary.

A feverish state with an increase in temperature of non-infectious etymology appears as a result of central or peripheral exposure to the decay products of leukocytes (endogenous pyrogens).

Fever is also classified according to temperature indicators:

subfebrile - from 37.2 to 38 degrees;
febrile low - from 38.1 to 39 degrees;
febrile high - from 39.1 to 40 degrees;
excessive - more than 40 degrees.

By duration There are different types of fever:

ephemeral - from several hours to 3 days;
acute - up to 14-15 days;
subacute - up to 44-45 days;
chronic - 45 or more days.

Survey methods

The attending physician sets himself the task of determining which types of bacteria or viruses turned out to be the causative agent of fever of unknown origin. They are especially susceptible to premature newborns up to six months of age, as well as adults with a weakened body due to a chronic disease or other reasons listed above.

To clarify the diagnosis, a number of laboratory research:

a general blood test to determine the content of platelets, leukocytes, ESR;
analysis of urine for the content of leukocytes in it;
blood chemistry;
blood cultures, urine, feces, mucus from the larynx for coughing.

In addition, in some cases, bacterioscopy to exclude the suspicion of malaria. Also, sometimes the patient is offered to undergo a comprehensive examination for tuberculosis, AIDS and other infectious diseases.

Fever of unknown origin is so difficult to diagnose that one cannot do without examinations using special medical equipment. The patient goes through:

tomography;
skeletal scan;
x-ray;
echocardiography;
colonoscopy;
puncture of the bone marrow;
biopsy of the liver, muscle tissues and lymph nodes.

The range of all diagnostic methods and means is quite wide; on their basis, the doctor develops a specific treatment algorithm for each patient. It takes into account the presence of obvious symptoms:

pain in the joints;
change in hemoglobin level;
inflammation of the lymph nodes;
the appearance of pain in the internal organs.

In this case, the doctor has the opportunity to go more purposefully to establish an accurate diagnosis.

Features of treatment

Despite the fact that a fever of unknown origin is a danger not only to health, but also to human life, one should not rush to take medications. Although some doctors prescribe antibiotics and carticosteroids long before determining the final diagnosis, motivating them to alleviate the physical condition of the patient as soon as possible. However, this approach does not allow making the right decision for more effective treatment. If the body is under the influence of antibiotics, it becomes more difficult to find the true cause of the fever in the laboratory.

According to most doctors, further examination of the patient should be carried out using only symptomatic therapy. It is carried out without the appointment of potent drugs that lubricate the clinical picture.

If the patient continues high fever He is advised to drink plenty of water. Foods that cause allergies are excluded from the diet.

If infectious manifestations are suspected, he is placed in an isolated ward of a medical institution.

Treatment medications carried out after the discovery of the disease that provoked the fever. If the etiology (causes of the disease) of fever after all diagnostic procedures has not been established, the use of antipyretics and antibiotics is allowed.

under the age of 2 years with a temperature above 38 degrees;
at any age after 2 years - over 40 degrees;
who have febrile convulsions;
who have CNS disease;
with dysfunctions of the circulatory system;
with obstructive syndrome;
with hereditary diseases.

Which doctor should I contact?

If an adult has obvious symptoms LNG, he should contact infectious disease specialist. Although most people turn to therapist. But if he notices the slightest suspicion of a fever, he will certainly refer you to an infectious disease specialist.

Many parents are interested in which doctors should be contacted at the first symptoms of the disease in question in children. First of all, to pediatrician. After the preliminary stage of the examination, the doctor refers the little patient to one or more specialized specialists: cardiologist, infectious disease specialist, allergist, endocrinologist, virologist, nephrologist, otolaryngologist, neurologist.

Each of these doctors takes part in the study of the patient's condition. If it is possible to determine the development of a concomitant disease, for example, associated with an allergic reaction to food or drugs, an allergist will help here.

Medical treatment

For each patient, the doctor develops an individual medication program. The specialist takes into account the condition against which the development of the disease occurs, determines the degree of hyperthermia, classifies the type of fever and prescribes medications.

According to doctors, medications not appointed at "pink" fever with an unburdened background (maximum temperature 39 degrees). If the patient does not have severe illness, the condition and behavior are adequate, it is recommended to limit yourself to drinking plenty of water and using body cooling methods.

If the patient belongs to a risk group and has "pale" fever, he is assigned Paracetamol or Ibuprofen . These drugs meet the criteria for therapeutic safety and efficacy.

According to the WHO, Aspirin refers to antipyretic drugs that are not used to treat children under 12 years of age. If the patient does not tolerate Paracetamol and Ibuprofen, he is prescribed Metamizole .

Doctors recommend taking Ibuprofen and Paracetamol at the same time, according to the developed scheme individually for each patient. With combined use, the dosage of such medications is minimal, but this gives a much greater effect.

There is a drug Ibuklin , one tablet of which will contain the low-dose components of paracetamol (125 mg) and ibuprofen (100 mg). This drug has a fast and prolonged effect. Children per day should take:

from 3 to 6 years (body weight 14-21 kg) 3 tablets;
from 6 to 12 years (22-41 kg) 5-6 tablets every 4 hours;
over 12 years old - 1 tablet.

Adults are prescribed dosage depending on age, body weight and physical condition body (presence of other diseases).
Antibiotics the doctor selects in accordance with the results of the tests:

antipyretics (Paracetamol, Indomethacin, Naproxen);
1 stage of taking antibiotics (Gentamicin, Ceftazidime, Azlin);
Stage 2 - appointment of more strong antibiotics(Cefazolin, Amphotericin, Fluconazole).

Folk recipes

On given hour ethnoscience presents a huge selection of funds for every occasion. Consider some recipes that help alleviate the condition with a fever of unknown origin.

A decoction of small periwinkle: Pour 1 tablespoon of dry leaves into a vessel with a glass of water, boil for 20-25 minutes. After an hour, strain, and the broth is ready. Drink the entire volume should be per day in 3 divided doses.

tench fish. Dried fish gallbladder must be powdered. It should be taken 1 bubble per day with water.

willow bark. Pour 1 teaspoon of bark into the brewing bowl, after crushing it, pour 300 ml of water. Boil, reducing the heat to a minimum, until about 50 ml has evaporated. It should be taken on an empty stomach, you can add a little honey to the broth. It is necessary to continue drinking until complete recovery.

LNG refers to diseases whose treatment is very difficult due to the difficulty of determining the causes of its occurrence, so you should not use folk remedies without the permission of your doctor.

Preventive measures for children and adults

To prevent a feverish state, elementary health care is necessary in the form of regular medical examination. Thus, it can be guaranteed timely detection all kinds of pathologies. The earlier the diagnosis of a particular disease is established, the more favorable the result of treatment will be. After all, it is the complication of a neglected disease that is most often the cause of a fever of unknown origin.

There are rules, the observance of which will reduce the likelihood of developing LNG in children to zero:

do not contact with infectious patients;
receive a complete balanced diet;
physical activity;
vaccination;
personal hygiene.

All of these recommendations are acceptable for adults with a small addition:

exclude random connections of a sexual nature;
use in intimate life methods of barrier contraception;
while abroad, do not eat unknown foods.

Infectionist about LNG (video)

The infectious disease doctor will tell you about the causes of fever, its types, methods of diagnosis and treatment in this video from his point of view.

An important point is the heredity and predisposition of the body to certain diseases. After a thorough comprehensive examination, the doctor will be able to make the correct diagnosis and prescribe an effective therapeutic course to eliminate the causes of fever.

Next article.

In clinical practice, situations often arise when, against the background of good health the patient suddenly rises natural temperature body (the indicator often exceeds the level of 38 ° C). Moreover, such prolonged hyperthermia may be the only symptom that indicates some violation in the body. But numerous diagnostic studies do not allow to determine a specific pathological process. In this case, the attending physician diagnoses the patient with "fever unclear etiology” and gives a referral for a more detailed examination of the state of health.

A feverish condition lasting more than 1 week is most likely caused by some serious illness. As practice shows, hyperthermia in about 90% of cases is an indicator of the course of the infectious process in the body, the presence of a malignant neoplasm, and damage to the connective tissues of a systemic nature. In rare cases, prolonged fever indicates atypical form the course of common diseases that the patient has encountered more than once in his life.

There are the following causes of fever of unknown origin:

Other causes of hyperthermia have also been identified. For example, drug or medicinal. Drug fever is a persistent fever caused by hypersensitivity to a number of certain drugs, which are most often used more than once. These may include painkillers, diuretics, some antibiotics, antihistamines, and sedatives.

Classification of fever of unknown origin

In medicine, several types of fever have been studied and distinguished depending on the nature of the change in body temperature over time:

Permanent (steady type). The temperature is high (about 39°C) and remains stable for several days. Fluctuations during the day do not exceed 1°C (pneumonia).
Relieving fever. Daily fluctuations are 1-2°C. The temperature does not drop to the usual level (diseases with purulent tissue damage).
Intermittent fever. Hyperthermia alternates with natural, healthy state patient (malaria).
Wavy. The increase in temperature occurs gradually, followed by the same systematic decrease to a subfebrile level (brucellosis, lymphogranulomatosis).
Wrong fever. During the course of hyperthermia, there is no regularity in daily change indicator (flu, cancer, rheumatism).
return type. Elevated temperature (up to 40 ° C) alternates with subfebrile condition (typhus).
Perverted fever. The morning temperature is higher than in the afternoon (diseases of viral etiology, sepsis).

Based on the duration of the disease, acute (less than 15 days), subacute (15-45 days) or chronic fever (over 45 days) are distinguished.

Symptoms of the disease

Usually single and bright severe symptom prolonged fever is elevated body temperature. But against the background of hyperthermia, other signs of an unknown disease may develop:

increased work of sweat glands;
suffocation;
chills;
pain in the region of the heart;
dyspnea.

Diagnosis of fever of unknown origin

Prolonged fever of unknown origin involves the use of standard and specific research methods. Making a diagnosis is considered a painstaking and time-consuming task. First of all, the patient needs to contact the therapist in the clinic. He will set the duration of hyperthermia, the peculiarity of its changes (fluctuations) during the day. Also, the specialist will determine what diagnostic methods the examination will consist of.

Standard diagnostic procedures for prolonged fever syndrome:

Blood and urine analysis (general), detailed coagulogram.
Biochemical study of blood from the cubital vein. Clinical data will be obtained on the amount of sugar, sialic acids, total protein, AST, CRP in the biomaterial.
The simplest diagnostic method is the aspirin test. The patient is asked to drink an antipyretic tablet (paracetamol, aspirin). After 40 minutes, observe whether the temperature has dropped. If there has been a change of at least one degree, it means that an inflammatory process is taking place in the body.
Mantoux test.
Three-hour thermometry (measurement of temperature indicators).
X-ray of the lungs. Used to determine such complex diseases as sarcoidosis, tuberculosis, lymphoma.
Ultrasound of the organs located in abdominal cavity and pelvic area. Used for suspected obstructive kidney disease, neoplasms in the organs, pathology of the biliary system.
ECG and EchoCG (it is advisable to perform with the likelihood of atrial myxoma, fibrosis of the heart valves, etc.).
CT or MRI of the brain.

If the above analyzes did not reveal specific disease or their results are controversial, then a series of additional studies is prescribed:

The study of information about possible hereditary diseases.
Obtaining information about the patient's existing allergic reactions. Especially those that arise on the basis of the use of drugs.
Examination of tissues and mucous membranes of the gastrointestinal tract for tumors and inflammatory processes. To do this, use endoscopy, the method of radiation diagnosis or a biopsy.
Serological studies blood, which is prescribed for suspected hepatitis, HIV infection, cytomegalovirus, amoebiasis, syphilis, brucellosis, infections caused by the Epstein-Barr virus.
Microbiological analyzes various kinds biomaterial of the patient - urine, blood, secretions from the nasopharynx. In some cases, a blood test for infections of intrauterine localization is necessary.
Microscopic analysis of a thick drop of blood (to exclude the malaria virus).
Taking and analysis of bone marrow puncture.
A blood mass test for the so-called antinuclear factor (lupus exclusion).

Differential diagnosis of fevers is divided into 4 main subgroups:

association of common infectious diseases.
oncology subgroup.
autoimmune pathologies.
other diseases.

During the differentiation procedure, the specialist should pay attention not only to those symptoms that bother a person in this moment time, but also to those with which he had previously encountered.

It is necessary to take into account the surgical operations, chronic diseases and psycho-emotional characteristics of each individual patient. If a man long time is taking any medications, he must inform the diagnostician about it.

Prevention of fever of unknown origin

Prevention, first of all, consists in quick and correct diagnosis diseases that cause a persistent increase in temperature for a long time. At the same time, you can not self-medicate, choose on your own even the simplest medicines.

A mandatory preventive measure is the constant maintenance high level immune protection. If one of the family members is found to have an infectious or viral disease should be isolated in a separate room.

To avoid pathological infections, it is better to have one (permanent) sexual partner and not neglect barrier contraceptives.

FEVER OF UNCLEAR GENESIS honey.
Fever of unknown origin - an increase in body temperature above 38.3 ° C at least 4 times within 14 days due to an undiagnosed disease.
Possible reasons
infectious and bacterial diseases
Abscesses of the abdomen
Mycobacterial infections
Cytomegalovirus
sinusitis
HIV infection
Endo- and pericarditis
Kidney and urinary tract infections
Osteomyelitis
Infections due to long-acting catheters
amoebic hepatitis
Wound infections
Neoplasms
Lipoma
Leukemia
solid tumors(hypernephroma)
Hepatoma
Atrial myxoma
colon cancer
Collagen-vascular diseases
Giant cell arteritis
Nodular periarteritis
Rheumatoid fever
SLE
Rheumatoid arthritis
Rheumatoid polymyalgia
Other reasons
Granulomatosis
Pulmonary embolism
Taking medications
Thermoregulation disorders
Endocrine diseases
Factors environment
Periodic fever
Violation of cerebral circulation
Alcoholic hepatitis.

Clinical picture

An increase in body temperature is not the only manifestation of the disease
The type and nature of the fever is usually uninformative
Symptoms associated with an increase in body temperature are headaches and muscle pain, general malaise.

Laboratory research

General and biochemical blood tests (leukopenia, anemia, thrombocytopenia or thrombocytosis are possible; increased CRP concentration; increased ESR)
Liver function tests (especially ALP) indicate inflammation, obstruction, or infiltrative organ damage
Bacterial culture blood. Perform several venous blood cultures (no more than 6) for the presence of possible bacteremia or septicemia
General analysis and bacterial culture of urine.

Special Studies

Comprehensive examination of a patient for tuberculosis
Tuberculin skin test is almost always negative in vigorous or acute infection (should be repeated after 2 weeks)
Bacterial culture of urine, sputum and gastric lavage to identify the causative agent of tuberculosis
Serological studies are carried out for infections caused by Epstshn-Barr viruses, hepatitis, cytomegalovirus, causative agents of syphilis, lymoborreliosis, Q-fever, amoebiasis and coccidioidomycosis. Mandatory HIV testing
Serum protein electrophoresis for suspected pathology of the immune system
Examination of thyroid function in case of suspected thyroiditis
Determination of RF and antinuclear antibodies in case of suspected collagenoses and vascular pathology
X-ray of organs chest, abdominal cavity, paranasal sinuses (according to clinical indications)
CT/MRI of the abdomen and pelvis, radioisotope scanning(in combination with direct biopsy according to indications) if an infectious process is suspected and volumetric education
Abdominal and pelvic ultrasonography (in combination with biopsy as indicated) for suspected mass lesion, obstructive kidney disease, or gallbladder and biliary tract pathology
Echocardiography for suspected valvular disease, atrial myxoma, pericardial effusion.
Diagnostic procedures
Bone marrow puncture for suspected granulomatosis, malignant neoplasms
Liver biopsy for suspected granulomatosis
Temporal artery biopsy for suspected giant cell arteritis
Biopsy of lymph nodes, muscles and skin (if indicated)
If the diagnostic procedures performed turned out to be uninformative, a diagnostic laparotomy is performed.

Treatment:

Tactics of conducting

It is necessary to establish the cause of fever using all possible methods
If the etiology of fever remains unclear, repeat the history, physical examination, and screening tests. laboratory research. Particular attention should be paid to previous tourist trips, sexual contacts, endemic factors, exposure to previously taken drugs.
With an increase in body temperature, increase the amount of fluid consumed.
Drug therapy. The drugs of choice are prescribed depending on the underlying disease. If the cause of fever is not established (in 20%), the following drugs can be prescribed
Antipyretics (paracetamol or aspirin)
[acetylsalicylic acid]). Aspirin is not prescribed for children, because. possible development of Reye's syndrome
Other prostaglandin synthetase inhibitors (indomethacin or naproxen)
Glucocorticoids (trial). After the use of glucocorticoids, relapse or activation of undiagnosed diseases (for example, tuberculosis) is possible
Antibiotics (trial, based on medical history).

Course and forecast

Depends on etiology and age
The one-year survival rate is 91% for those under 35, 82% for those aged 35-64, and 67% for those over 64.

Age features

Children and teenagers. The most common possible causes are collagenous-vascular diseases, infectious processes, inflammatory diseases intestines
Elderly
Possible reasons - acute leukemia, Hodgkin's disease, intra-abdominal infections, tuberculosis and arteritis of the temporal artery
Signs and symptoms are less specific
Concomitant diseases and reception various drugs may mask a fever
The mortality rate is higher than in other age groups.
Pregnancy. An increase in body temperature increases the risk of developing defects in the formation of the neural tube of the fetus, causing premature birth.
See also giant cell arteritis. Chronic juvenile arthritis, HIV infection and AIDS, Systemic lupus erythematosus, Hepatoma, Wegener's granulomatosis, Cytomegalovirus infection, Infectious endocarditis

Causes of the disease

A feverish condition that lasts no more than 1 week indicates an infection. It is assumed that prolonged fever is associated with the course of any serious pathology.

Fever of unknown origin in children or adults may be the result of an overdose of drugs:

antimicrobial agents;
antibiotics;
sulfonamides;
nitrofurans;
anti-inflammatory drugs;
drugs that are prescribed for diseases of the gastrointestinal tract;
cardiovascular drugs;
cytostatics;
antihistamines;
iodine preparations;
substances that affect the CNS.

The medicinal nature is not confirmed in those cases when, within 1 week after discontinuation of the drug, the temperature values \u200b\u200bremain high.

Causes of fever of unknown origin

Classification

Based on the nature of the course, fever of unknown origin is:

classical - against the background of pathologies known to science;
nosocomial - occurs in persons who are in the intensive care unit for more than 2 days;
neutropenic - there is a decrease in the number of neutrophils in the blood;
HIV-associated.

According to the level of temperature increase in LNG, it happens:

subfebrile - varies from 37.2 to 37.9 degrees;
febrile - is 38–38.9 degrees;
pyretic - from 39 to 40.9;
hyperpyretic - above 41 degrees.

According to the type of changes in values, the following types of hyperthermia are distinguished:

constant - daily fluctuations do not exceed 1 degree;
relaxing - variability throughout the day is 1-2 degrees;
intermittent - there is an alternation of the normal state with the pathological, the duration is 1-3 days;
hectic - there are sharp jumps in temperature indicators;
wavy - the thermometer indicators gradually decrease, after which they increase again;
perverted - indicators are higher in the morning than in the evening;
wrong - has no patterns.

The duration of a fever of unknown origin can be:

acute - lasts no longer than 15 days;
subacute - the interval is from 16 to 45 days;
chronic - more than 1.5 months.

Symptoms of the disease

The main, and in some cases the only, symptom of a fever of unknown origin is an increase in body temperature.

The peculiarity of this condition is that the pathology for a rather long period of time can proceed completely asymptomatically or with erased symptoms.

Main additional manifestations:

muscle and joint pain;
dizziness;
feeling short of breath;
increased heart rate;
chills;
increased sweating;
pain in the heart, in the lower back or in the head;
lack of appetite;
stool disorder;
nausea and vomiting;
weakness and weakness;
frequent mood swings;
strong thirst;
drowsiness;
pallor of the skin;
decrease in performance.

External signs occur in both adults and children. However, in the second category of patients, the severity of concomitant symptoms may be much higher.

Diagnostics

Diagnosis of fever of unknown origin

The first step in establishing a correct diagnosis includes:

study of the medical history - to search for chronic diseases;
collection and analysis of life history;
a thorough physical examination of the patient;
listening to a person with a phonendoscope;
measurement of temperature values;
a detailed survey of the patient for the first time of occurrence of the main symptom and the severity of concomitant external manifestations and hyperthermia.

Laboratory research:

general clinical and biochemical blood tests;
microscopic examination of feces;
general analysis of urine;
bacterial culture of all human biological fluids;
hormonal and immunological tests;
bacterioscopy;
serological reactions;
PCR tests;
Mantoux test;
tests for AIDS and HIV.

Instrumental diagnosis of fever of unknown origin involves the following procedures:

radiography;
CT and MRI;
scanning of the skeletal system;
ultrasonography;
ECG and echocardiography;
colonoscopy;
puncture and biopsy;
scintigraphy;
densitometry;
EFGDS;
MSCT.

Densitometry

Consultations of specialists from various fields of medicine are necessary, for example, gastroenterology, neurology, gynecology, pediatrics, endocrinology, etc. Depending on which doctor the patient goes to, additional diagnostic procedures may be prescribed.

The differential diagnosis is divided into the following main subgroups:

infectious and viral diseases;
oncology;
autoimmune diseases;
systemic disorders;
other pathologies.

Treatment of the disease

When a person's condition is stable, experts recommend refraining from treating fever of unknown origin in children and adults.

In all other situations, trial therapy is performed, the essence of which will differ depending on the alleged provocateur:

with tuberculosis, anti-tuberculosis substances are prescribed;
infections are treated with antibiotics;
viral diseases are eliminated with the help of immunostimulants;
autoimmune processes - a direct indication for the use of glucocorticoids;
for diseases of the gastrointestinal tract, in addition to medicines, diet therapy is prescribed;
when malignant tumors are detected, surgery, chemotherapy and radiotherapy are indicated.

If medicinal LNG is suspected, the medications taken by the patient should be discontinued.

Prevention and prognosis

To reduce the likelihood of developing a pathological condition, it is necessary to adhere to preventive recommendations aimed at preventing the occurrence of a possible disease provocateur.

Prevention:

maintaining a healthy lifestyle;
complete and balanced nutrition;
avoiding the influence of stressful situations;
prevention of any injury;
permanent strengthening of the immune system;
taking medications in accordance with the recommendations of the clinician who prescribed them;
early diagnosis and full treatment of any pathologies;

Chronic pelvic pain syndrome (CPPS, formerly known as prostatodynia) in men is a chronic,

About,

FEVER OF UNCLEAR GENESIS: IS DECRYPTION REAL?

Dvoretsky L.I.

The term "fever of unknown origin" (LNG) refers to situations that are often encountered in clinical practice, in which fever is the main or only sign of various diseases, the diagnosis of which remains unclear after a routine, and in some cases additional examination. The spectrum of diseases underlying LNG is quite wide and includes various diseases. infectious nature, malignant tumors, systemic vasculitis, as well as other diseases of various origins. In a small proportion of patients, the cause of the fever remains undeciphered. LNG is based on common diseases with an unusual course. Diagnostic search for LNG includes the identification of additional clinical and laboratory signs that determine the nature of a targeted examination using the most informative for this situation. diagnostic methods. The question of the advisability of prescribing treatment, including trial, before deciphering LNG should be decided individually, depending on the specific clinical situation.

The term "fever of unknown genesis" (FUG) implies common clinical conditions while fever is a main or sole sign of different diseases whose diagnosis remains unclear after routine and, in some cases, additional studies. The range of diseases underlying FUG is rather wide and includes different diseases of infectious origin, malignant tumors, systemic vasculitis and other diseases of various genesis. FUG is caused by common diseases having an unusual course. In FUG, diagnostic search includes identification of additional clinical and laboratory signs that determine the nature of a goal-oriented examination by using the diagnostic methods which are informative for a specific condition. Whether it is advisable to prescribe treatment, including presumptive one, and to decipher FUG should be determined on an individual basis as a specific clinical situation requires.

L.I. Butler MMA them. THEM. Sechenov

I.M.Sechenov Noscow Medical Academy

Even ancient doctors knew that fever is one of the signs of many diseases, which were often called simply "fever". After the German clinician Wunderlich pointed out the importance of measuring body temperature in 1868, thermometry became one of the few simple methods objectification and quantitative assessment of the disease. After the introduction of thermometry, it became no longer customary to speak

that the patient suffers from "fever". The doctor's task was to determine the cause of the fever. However, the level medical technologies the past did not always allow to reliably determine the cause of febrile conditions, especially long-term ones. Many clinicians of the past, based in the diagnosis only on personal experience and intuition, earned themselves a high medical reputation precisely because of the successful diagnosis of febrile diseases. With the improvement of old and the emergence of new diagnostic methods, there has been progress in deciphering the causes of many cases of fever. However, to this day, prolonged fevers of unknown origin remain one of the diagnostic problems in clinical practice.

Probably, each clinician had to observe more than one patient with prolonged fever, which is the main or only sign of the disease, the diagnosis of which remained unclear after the usual, and in some cases, additional examinations. Such situations give rise

a number of additional problems associated not only with the ambiguity of the diagnosis and the delay in treatment for an indefinite period, but also with the patient's long stay in the hospital, a large amount of examination, often expensive, and the patient's loss of confidence in the doctor. In this regard, to designate such situations and single them out as a special group requiring a specific approach, it was proposed

the term "fever of unknown origin" (FUN). This term has firmly entered the clinical lexicon and has become widespread in the medical literature, including number and in one of the most popular

reference and bibliographic publications "Index Medicus". Clinical practice and analysis of the literature testify to the ambiguous interpretation and arbitrary use of the term LNG by some clinicians without taking into account the degree of fever, its duration and other signs. This, in turn, makes it difficult to develop standard approach to a diagnostic search. Meanwhile, at one time, the criteria were precisely defined, allowing us to regard the clinical situation as LNG:

– the patient has a temperature of 38°C (101°F) or higher;

– the duration of fever is 3 weeks or more, or periodic rises in temperature during this period;

– ambiguity of the diagnosis after the examination using generally accepted

(routine) methods.

Thus, a peculiar syndrome (LNG-syndrome) was identified, which differs from other cases of fever. Based on these criteria, LNG should not include cases of so-called obscure subfebrile conditions, which are often incorrectly referred to as LNG. Meanwhile, unclear subfebrile conditions occupy a special place in clinical practice and require a different diagnostic approach. In most cases, unclear subfebrile conditions are one of the manifestations autonomic dysfunctions, although they may also be due to the presence of an infectious-inflammatory process (tuberculosis). An important criterion is the duration of fever for at least 3 weeks, and therefore short-term temperature increases, even of unclear origin, do not meet the criteria for LNG. The last criterion (ambiguity of diagnosis) is decisive and allows us to interpret the situation as LNG, since the information obtained during the generally accepted (routine) examination of the patient does not allow us to decipher the cause of the fever.

The allocation of patients with LNG to a special group serves primarily practical purposes. It is necessary for doctors to develop the skills of a rational diagnostic search using, in each specific case, adequate informative methods research based on knowledge of the characteristics of diseases manifested by LNG. The range of these diseases is quite extensive and includes diseases related to the competence of the therapist, surgeon, oncologist, infectious disease specialist and other specialists. However, until the true nature of LNG is deciphered, patients, as a rule, are in general therapeutic departments, less often in specialized departments, where they are admitted, depending on the nature of the symptoms, with suspected pneumonia, urinary tract infections, rheumatic and other diseases.

Nosological structure of the causes of LNG for Lately is undergoing changes. So, among the "feverish" diseases, some forms of infections with immunodeficiencies, various types of nosocomial infections, boreliosis, mononucleosis syndrome, etc. began to appear.

WITH With this in mind, it was proposed to allocate 4 groups of LNG:

1) "classic" variant of LNG, which includes, along with previously known, some new diseases (Lyme disease, syndrome chronic fatigue); 2) LNG against the background of neutropenia;

3) nosocomial LNG; 4) LNG associated with HIV infection (microbacteriosis, cytomegalovirus infection, cryptococcosis, histoplasmosis).

In this article, LNG of the 1st group will be considered mainly. They are based not on rare or unusual pathological processes, but on good known to physicians disease, course

which is the predominance of febrile syndrome. These are, as a rule, "common diseases with an unusual course."

An analysis of literature data and our own clinical experience indicate that LNG is most often based on diseases that can be conditionally divided into several groups. Specific gravity

each of these groups fluctuates, according to different authors, which can be determined by various

factors (specifics of hospitals, in which patients are examined, the level of examination, etc.). So, the cause of LNG can be:

generalized or local infectious and inflammatory processes - 30-50% of all cases of LNG;

tumor diseases - 20–30%;

systemic lesions of the connective tissue (systemic vasculitis) - 10–20%;

other diseases, diverse in etiology, pathogenesis, methods of diagnosis, treatment and prognosis - 10–20%;

in approximately 10% of patients, the cause of the fever cannot be deciphered

despite thorough examination using modern informative methods.

An increase in body temperature during these pathological processes is ultimately due to the effect of endogenous pyrogen on the thermoregulatory center located in the anterior hypothalamus. Endogenous pyrogen refers, according to modern concepts, to interleukins and is produced by macrophages, monocytes, neutrophils and, to a lesser extent, eosinophils as a result of an immune response to various microbial and non-microbial antigens, immune complexes, sensitized T-lymphocytes, endotoxins various origins, products of cellular decay. The ability to produce endogenous pyrogen is also possessed by cells of various malignant tumors(lymphoproliferative tumors, tumors of the kidneys, liver, etc.). Product Fact tumor cells pyrogen has been experimentally proven and confirmed in clinical setting disappearance of fever surgical removal tumor or initiation of chemotherapy for lymphoproliferative disease.

Infectious and inflammatory diseases

The presence of LNG is traditionally associated in most doctors primarily with the infectious process and encourages the appointment of antimicrobials even before the results of the examination are received. Meanwhile, infectious and inflammatory processes underlie LNG in less than half of the patients in this group.

Tuberculosis

Various forms of tuberculosis (TBC) continue to be one of the common causes LNG, and among the infectious and inflammatory processes, according to most publications, occupy a leading place. The latter is the cause of LNG in about half of patients after kidney transplantation. Infectious mononucleosis can proceed atypically and take a protracted course in the absence of altered lymphocytes and lymphadenopathy. A similar course gave reason to isolate the so-called chronic mononucleosis syndrome. High sensitivity and specificity for the detection of the virus has PCR.

special group infectious pathology in cases of LNG, it is HIV infection, the spread of which over the past decades in many countries has changed the structure of the causes of LNG. In this regard, a diagnostic search for LNG should, apparently, necessarily include an examination for the presence of not only HIV infection, but also those infections that are often associated with AIDS (microbacteriosis, coccidiomycosis, histoplasmosis, etc.).

Tumor diseases

The second place in the structure of the causes of LNG is occupied by tumor processes of various localization, including hemoblastoses. The most frequently diagnosed lymphoproliferative tumors (lymphogranulomatosis, lymphosarcoma), kidney cancer, liver tumors (primary and metastatic). Among other tumors, bronchogenic cancer, cancer of the colon, pancreas, stomach and some other localizations are detected.

According to the data available in the literature, there was practically no localization of the tumor that would not be detected in cases of LNG of a “tumor nature”. Taking into account the probability of the presence of a tumor of any localization in LNG, oncological search in these patients should be aimed not only at the most vulnerable "tumor targets", but also at other organs and tissues.

The main difficulties in timely recognition of the tumor process in patients with LNG are usually due to minimal local manifestations or their absence. In addition, the oncological search is often delayed due to the prevailing view of doctors on fever as a manifestation of a mainly infectious process, and therefore antibacterial drugs that do not affect the temperature are consistently prescribed.

In some cases, the idea of a tumor in LNG can be suggested by such non-specific syndromes as erythema nodosum (especially recurrent), hypertrophic osteoarthropathy, migratory thrombophlebitis, and some others. Unfortunately, these signs are not always correctly assessed and treated as paraneoplastic only retrospectively.

The mechanism of the occurrence of fever in tumor processes is probably associated with the production tumor tissue various pyrogenic substances (interleukin-1, etc.), and not with decay or perifocal inflammation.

One of the first signs of the effectiveness of treatment after the start of therapy with cytotoxic drugs for certain hemoblastoses, such as lymphogranulomatosis, or surgical removal of the tumor, is the normalization of temperature. The production of pyrogenic lymphokines by lymphocytes that are activated in response to the development of the tumor process is also not excluded. Fever does not depend on the size of the tumor and can be observed as with widespread tumor process, and in patients with the presence of one tumor node of a small size. In this regard, it is appropriate to mention the case of LNG in the patient with pheochromoblastoma observed by us, which was detected only at post-mortem histological examination adrenal.

Oncological search in patients with LNG should include non-invasive methods of examination

(ultrasound, computed tomography, nuclear magnetic resonance), radioisotope scanning of lymph nodes, skeleton, organs abdominal cavity, puncture biopsies,

endoscopic methods, including laparoscopy, and, if necessary, diagnostic laparotomy. Immunological research methods should be used to detect some specific tumor markers, in particular, o-fetoprotein (primary liver cancer), CA 19–9 (pancreatic cancer), CEA (colon cancer), PSA (prostate cancer).

The identification of the above markers will allow for a more targeted diagnostic search to exclude a tumor disease.

Systemic diseases

This group of diseases is the third most common cause of LNG and is represented mainly by diseases such as systemic lupus erythematosus (SLE), rheumatoid arthritis, Still's disease in adults, various forms systemic vasculitis (nodular arteritis, temporal arteritis, etc.), the so-called cross syndromes (Overlaps).

Habitual diagnostic features of the above diseases are insufficiently expressed or absent in febrile debuts of SLE and other systemic vasculitis, when fever is ahead of the onset of articular syndrome or other systemic disorders. In such situations, the suspicion of a systemic pathology, which determines the direction of the diagnostic search, may occur when dynamic observation for patients after revealing other clinical and laboratory signs. At the same time, the correct assessment of all symptoms that seem nonspecific or associated usually

with the fever itself (myalgia, muscle weakness, headache and etc.). Thus, the combination of these symptoms with fever, especially when increase in ESR, gives reason to suspect diseases such as dermatomyositis (polymyositis), polymyalgia rheumatica, temporal arteritis. Rheumatic polymyalgia maybe on early stages manifest fever in combination with pain in the proximal parts of the shoulder and pelvic girdle. Attention should be paid to the elderly and senile age of patients, a sharp increase in ESR. Polymyalgia rheumatica is often combined with temporal arteritis, characterized by the appearance of localized headaches, thickening of the temporal

arteries with weakening or absence of their pulsation. Verification of the diagnosis is possible with the help of a biopsy of the so-called temporal complex, upon receipt of which it is possible to examine the skin, muscle tissue, temporal artery. With a high probability of the disease, trial treatment with glucocorticoids in small doses (15-20 mg / day) is possible.

The effectiveness of the latter in this pathology is so specific that it can have

diagnostic value. At the same time, the use of glucocorticoids as a trial treatment should be avoided without sufficiently substantiated suspicion of the presence of a systemic disease.

As a cause of prolonged fever, Still's disease in adults is more often diagnosed - a disease with a less defined nosological framework and no specific laboratory signs.

Along with fever, mandatory symptoms are arthritis (or arthralgia in the debut), maculopapular rash, neutrophilic leukocytosis. Often there are pharyngitis, lymphadenopathy, enlargement of the spleen, serositis, myalgia. Rheumatoid and antinuclear factors are absent. This symptom complex makes one suspect various infections, sepsis and prescribe massive antimicrobial therapy that is ineffective. Diagnosis is made by ruling out infections and other systemic diseases.

Among the causes of LNG, rheumatic fever with the absence of microorganisms in the blood (abacterial endocarditis) and changing auscultatory symptoms remains relevant. The fever is antibiotic resistant but treatable with salicylates and glucocorticoids.

Other diseases

This heterogeneous group includes the most diverse in terms of etiology, methods of diagnosis, treatment and prognosis of the disease. According to many authors, LNG in a number of patients may be based on diseases such as Crohn's disease, ulcerative colitis, diverticulitis, thyroiditis, granulomatous diseases (sarcoidosis, granulomatous hepatitis), thrombophlebitis of the veins of the lower leg and pelvis, pulmonary embolism, nonspecific pericarditis, benign peritonitis (periodic disease) chronic alcoholic hepatitis and a number of other diseases. The peculiarity of these diseases of various origins is atypical course, manifested mainly by a febrile syndrome without clearly expressed organ symptoms, which makes it difficult to decipher the nature of LNG.

Vascular thromboses

In some patients, fever may be the only or one of the main manifestations of deep vein thrombophlebitis of the extremities, pelvis, or recurrent pulmonary embolism. Such situations occur more often after childbirth, bone fractures, surgical interventions, in the presence of intravenous catheters, in patients with atrial fibrillation, heart failure. In deep vein thrombosis, a qualified Doppler study of the corresponding vessels may have some diagnostic value. Heparin is able to completely stop or reduce fever within 48-72 hours, while antibiotics are not effective. Taking into account

Therefore, if this pathology is suspected, it is possible to prescribe a trial treatment with heparin, the effect of which may be of diagnostic value and determine the further management of patients.

Thyroiditis

In almost all publications, among the diseases detected in LNG, there are isolated cases thyroiditis, in particular subacute forms. Common for subacute thyroiditis local symptoms and signs of dysfunction of the thyroid gland in these situations are not leading. Absence or weak expression pain syndrome at first, it does not allow the doctor to include this disease in the range of diagnostic search. In this regard, sufficient attention is not always paid to the examination of the thyroid gland (examination, palpation), which could determine the direction of the diagnostic search. Sometimes it is possible to obtain information (often retrospectively) about short-term pain or discomfort in the neck. To rule out thyroiditis in cases of LNG, it may be useful ultrasonography thyroid gland, scan.

drug fevers

Fever occupies 3-5% in the structure of adverse reactions to medications, and often it is the only or main complication.

Drug-induced fevers may occur at various intervals (days, weeks) after the administration of the drug and do not have any specific signs to distinguish them from fevers of other origins. The only sign of the medicinal nature of the fever should be considered its disappearance after the withdrawal of the suspected drug.

Normalization of temperature does not always occur in the first days, but often a few days after cancellation, especially with violations drug metabolism, delayed excretion of the drug, as well as damage to the kidneys and liver. However, in most cases, with continued high temperature within a week after discontinuation of the drug, the drug nature of the fever becomes unlikely

The most common fever occurs with the use of the following groups of medicines:

– antimicrobials (penicillins, cephalosporins, tetracyclines, isoniazid, nitrofurans, sulfonamides, amphotericin B);

– cytotoxic drugs (bleomycin, asparaginase, procarbazine);

– cardiovascular drugs (alfamethyldopa, quinidine, procainamide, hydralazine);

– drugs acting on the central nervous system (diphenylhydantoin, carbamazepine, chlorpromazine, haloperidol, thioridazine);

– anti-inflammatory drugs (aspirin, ibuprofen, tolmetin);

– various groups of drugs, including iodine, antihistamines, clofibrate, allopurinol, levamisole, metoclopramide, cimetidine, etc.

Artificial fevers

Artificial fevers are caused by manipulating a thermometer, as well as by ingestion or injection under the skin into the urinary tract of various substances with pyrogenic properties. In such situations, most often we are talking about a special kind mental disorders with hypochondriacal manifestations, characterized by painful concentration on the state of one's own health, careful scrupulous observation of the slightest changes in well-being and condition (body temperature, magnitude blood pressure, bowel function, etc.). Such patients are characterized by a certain type of behavior that is difficult to explain from the generally accepted point of view, for example, the desire for multiple examinations, often invasive (some patients insist on surgical interventions). Patients believe that they are suspected of simulation, underestimate the severity of their condition, the severity and danger of the disease. Perhaps in this regard, they tend to demonstrate more obvious and objective signs of the disease, such as fever, bleeding, thereby trying to attract the attention of doctors. The described behavior should not be considered

In clinical practice, situations often arise when, against the background of good health, the patient's natural body temperature suddenly rises (the indicator often exceeds the level of 38 ° C). Moreover, such prolonged hyperthermia may be the only symptom that indicates some violation in the body. But numerous diagnostic studies do not allow to determine a specific pathological process. In this case, the attending physician diagnoses the patient with "fever of unknown etiology" and gives a referral for a more detailed examination of the state of health.

A feverish condition lasting more than 1 week is most likely caused by some serious illness. As practice shows, hyperthermia in about 90% of cases is an indicator of the course of the infectious process in the body, the presence of a malignant neoplasm, and damage to the connective tissues of a systemic nature. In rare cases, prolonged fever indicates an atypical form of the course of common diseases that the patient has encountered more than once in his life.

There are the following causes of fever of unknown origin:

In medicine, several types of fever have been studied and distinguished depending on the nature of the change in body temperature over time:

Permanent (steady type). The temperature is high (about 39°C) and remains stable for several days. Fluctuations during the day do not exceed 1°C (pneumonia).
Relieving fever. Daily fluctuations are 1-2°C. The temperature does not drop to the usual level (diseases with purulent tissue damage).
Intermittent fever. Hyperthermia alternates with the natural, healthy state of the patient (malaria).
Wavy. The increase in temperature occurs gradually, followed by the same systematic decrease to a subfebrile level (brucellosis, lymphogranulomatosis).
Wrong fever. During the course of hyperthermia, there is no regularity in the daily change in the indicator (flu, cancer, rheumatism).
return type. Elevated temperature (up to 40 ° C) alternates with subfebrile condition (typhus).
Perverted fever. The morning temperature is higher than in the afternoon (diseases of viral etiology, sepsis).

Based on the duration of the disease, acute (less than 15 days), subacute (15-45 days) or chronic fever (over 45 days) are distinguished.

Symptoms of the disease

Usually the only and pronounced symptom of prolonged fever is fever. But against the background of hyperthermia, other signs of an unknown disease may develop:

increased work of sweat glands;
suffocation;
chills;
pain in the region of the heart;
dyspnea.

Diagnosis of fever of unknown origin

Standard diagnostic procedures for prolonged fever syndrome:

Blood and urine analysis (general), detailed coagulogram.
Biochemical study of blood from the cubital vein. Clinical data will be obtained on the amount of sugar, sialic acids, total protein, AST, CRP in the biomaterial.
The simplest diagnostic method is the aspirin test. The patient is asked to drink an antipyretic tablet (paracetamol, aspirin). After 40 minutes, observe whether the temperature has dropped. If there has been a change of at least one degree, it means that an inflammatory process is taking place in the body.
Mantoux test.
Three-hour thermometry (measurement of temperature indicators).
X-ray of the lungs. Used to determine such complex diseases as sarcoidosis, tuberculosis, lymphoma.
Ultrasound of the organs located in the abdominal cavity and pelvic region. Used for suspected obstructive kidney disease, neoplasms in the organs, pathology of the biliary system.
ECG and EchoCG (it is advisable to perform with the likelihood of atrial myxoma, fibrosis of the heart valves, etc.).
CT or MRI of the brain.

If the above tests did not reveal a specific disease or their results are controversial, then a series of additional studies is prescribed:

The study of information about possible hereditary diseases.
Obtaining information about the patient's allergic reactions. Especially those that arise on the basis of the use of drugs.
Examination of tissues and mucous membranes of the gastrointestinal tract for tumors and inflammatory processes. To do this, use endoscopy, the method of radiation diagnosis or a biopsy.
Serological blood tests that are prescribed for suspected hepatitis, HIV infection, cytomegalovirus, amebiasis, syphilis, brucellosis, infections caused by the Epstein-Barr virus.
Microbiological analyzes of various types of patient biomaterial - urine, blood, secretions from the nasopharynx. In some cases, a blood test for infections of intrauterine localization is necessary.
Microscopic analysis of a thick drop of blood (to exclude the malaria virus).
Taking and analysis of bone marrow puncture.
A blood mass test for the so-called antinuclear factor (lupus exclusion).

Differential diagnosis of fevers is divided into 4 main subgroups:

association of common infectious diseases.
oncology subgroup.
autoimmune pathologies.
other diseases.

During the differentiation procedure, the specialist should pay attention not only to the symptoms that bother the person at the given time, but also to those that he encountered earlier.

It is necessary to take into account the performed surgical operations, chronic diseases and psycho-emotional characteristics of each individual patient. If a person has been taking any medications for a long time, he must inform the diagnostician about this.

Treatment of the disease
Drug therapy will be prescribed based on the characteristics of the underlying disease. If it has not yet been detected, but there is a suspicion of an infectious process, the patient must be hospitalized.

At home, you can conduct a course of antibiotic therapy (using penicillin rad drugs). The use of non-steroidal antipyretics is allowed.

Prevention of fever of unknown origin

Prevention, first of all, consists in the rapid and correct diagnosis of diseases that cause a persistent increase in temperature for a long time. At the same time, you can not self-medicate, choose on your own even the simplest medicines.

A mandatory preventive measure is the constant maintenance of a high level of immune protection. If an infectious or viral disease is found in one of the family members, it should be isolated in a separate room.

To avoid pathological infections, it is better to have one (permanent) sexual partner and not neglect barrier contraceptives.