Fever in which the etiology cannot be ascertained.
An abnormal elevation of body temperature, usually as a result of a pathologic process.
Metastases in which the tissue of origin is unknown.
An acute infectious disease caused by COXIELLA BURNETII. It is characterized by a sudden onset of FEVER; HEADACHE; malaise; and weakness. In humans, it is commonly contracted by inhalation of infected dusts derived from infected domestic animals (ANIMALS, DOMESTIC).
Infection of the spleen with species of MYCOBACTERIUM.
Systemic-onset rheumatoid arthritis in adults. It differs from classical rheumatoid arthritis in that it is more often marked by acute febrile onset, and generalized lymphadenopathy and hepatosplenomegaly are more prominent.
Development of lesions in the lymph node characterized by infiltration of the cortex or paracortex by large collections of proliferating histiocytes and complete or, more often, incomplete necrosis of lymphoid tissue.
An acute infectious disease primarily of the tropics, caused by a virus and transmitted to man by mosquitoes of the genera Aedes and Haemagogus. The severe form is characterized by fever, HEMOLYTIC JAUNDICE, and renal damage.
An acute systemic febrile infection caused by SALMONELLA TYPHI, a serotype of SALMONELLA ENTERICA.
Invasion of the host organism by microorganisms that can cause pathological conditions or diseases.
A blood-filled VAGINA that is obstructed.
A rare form of non-Langerhans-cell histiocytosis (HISTIOCYTOSIS, NON-LANGERHANS-CELL) with onset in middle age. The systemic disease is characterized by infiltration of lipid-laden macrophages, multinucleated giant cells, an inflammatory infiltrate of lymphocytes and histiocytes in the bone marrow, and a generalized sclerosis of the long bones.
Tomography using x-ray transmission and a computer algorithm to reconstruct the image.
A transient loss of consciousness and postural tone caused by diminished blood flow to the brain (i.e., BRAIN ISCHEMIA). Presyncope refers to the sensation of lightheadedness and loss of strength that precedes a syncopal event or accompanies an incomplete syncope. (From Adams et al., Principles of Neurology, 6th ed, pp367-9)
Death resulting from the presence of a disease in an individual, as shown by a single case report or a limited number of patients. This should be differentiated from DEATH, the physiological cessation of life and from MORTALITY, an epidemiological or statistical concept.
Unstable isotopes of gallium that decay or disintegrate emitting radiation. Ga atoms with atomic weights 63-68, 70 and 72-76 are radioactive gallium isotopes.
A slow-growing benign pseudotumor in which plasma cells greatly outnumber the inflammatory cells.
An idiopathic systemic inflammatory granulomatous disorder comprised of epithelioid and multinucleated giant cells with little necrosis. It usually invades the lungs with fibrosis and may also involve lymph nodes, skin, liver, spleen, eyes, phalangeal bones, and parotid glands.
A unique DNA sequence of a replicon at which DNA REPLICATION is initiated and proceeds bidirectionally or unidirectionally. It contains the sites where the first separation of the complementary strands occurs, a primer RNA is synthesized, and the switch from primer RNA to DNA synthesis takes place. (Rieger et al., Glossary of Genetics: Classical and Molecular, 5th ed)
Disorders of the mediastinum, general or unspecified.
Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.
A form of necrotizing non-granulomatous inflammation occurring primarily in medium-sized ARTERIES, often with microaneurysms. It is characterized by muscle, joint, and abdominal pain resulting from arterial infarction and scarring in affected organs. Polyarteritis nodosa with lung involvement is called CHURG-STRAUSS SYNDROME.
A febrile disease occurring as a delayed sequela of infections with STREPTOCOCCUS PYOGENES. It is characterized by multiple focal inflammatory lesions of the connective tissue structures, such as the heart, blood vessels, and joints (POLYARTHRITIS) and brain, and by the presence of ASCHOFF BODIES in the myocardium and skin.
Diseases of LYMPH; LYMPH NODES; or LYMPHATIC VESSELS.
A standard and widely accepted diagnostic test used to identify patients who have a vasodepressive and/or cardioinhibitory response as a cause of syncope. (From Braunwald, Heart Disease, 7th ed)
Descriptions of specific amino acid, carbohydrate, or nucleotide sequences which have appeared in the published literature and/or are deposited in and maintained by databanks such as GENBANK, European Molecular Biology Laboratory (EMBL), National Biomedical Research Foundation (NBRF), or other sequence repositories.
Enlargement of the liver.
Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body.
Binary classification measures to assess test results. Sensitivity or recall rate is the proportion of true positives. Specificity is the probability of correctly determining the absence of a condition. (From Last, Dictionary of Epidemiology, 2d ed)
An acute infection caused by the RIFT VALLEY FEVER VIRUS, an RNA arthropod-borne virus, affecting domestic animals and humans. In animals, symptoms include HEPATITIS; abortion (ABORTION, VETERINARY); and DEATH. In humans, symptoms range from those of a flu-like disease to hemorrhagic fever, ENCEPHALITIS, or BLINDNESS.
A decrease in the number of NEUTROPHILS found in the blood.
Enlargement of the spleen.
A group of viral diseases of diverse etiology but having many similar clinical characteristics; increased capillary permeability, leukopenia, and thrombocytopenia are common to all. Hemorrhagic fevers are characterized by sudden onset, fever, headache, generalized myalgia, backache, conjunctivitis, and severe prostration, followed by various hemorrhagic symptoms. Hemorrhagic fever with kidney involvement is HEMORRHAGIC FEVER WITH RENAL SYNDROME.
An acute febrile human disease caused by the LASSA VIRUS.
The relationships of groups of organisms as reflected by their genetic makeup.
Inflammation of any one of the blood vessels, including the ARTERIES; VEINS; and rest of the vasculature system in the body.

Human immunodeficiency virus-associated fever of unknown origin: a study of 70 patients in the United States and review. (1/299)

To characterize the clinical features of human immunodeficiency virus (HIV)-associated fever of unknown origin (FUO) in the United States, we performed a retrospective analysis of cases that fulfilled specific criteria (published by Durack and Street in 1991) at two medical centers in the United States between 1992 and 1997. Seventy cases met criteria for HIV-associated FUO; the mean CD4 cell count was 58/mm3, and the mean duration of fever was 42 days. A cause of FUO was found in 56 of the 70 cases; 43 were of a single etiology, and in 13 cases multiple conditions were established. The most common diagnoses were disseminated Mycobacterium avium infection (DMAC; 31%), Pneumocystis carinii pneumonia (13%), cytomegalovirus infection (11%), disseminated histoplasmosis (7%), and lymphoma (7%). In this United States series, FUO occurs most often in the late stage of HIV infection, individual cases often have multiple etiologies, and DMAC is the most common diagnosis.  (+info)

Pneumonia in febrile neutropenic patients and in bone marrow and blood stem-cell transplant recipients: use of high-resolution computed tomography. (2/299)

PURPOSE: To obtain statistical data on the use of high-resolution computed tomography (HRCT) for early detection of pneumonia in febrile neutropenic patients with unknown focus of infection. MATERIALS AND METHODS: One hundred eighty-eight HRCT studies were performed prospectively in 112 neutropenic patients with fever of unknown origin persisting for more than 48 hours despite empiric antibiotic treatment. Fifty-four of these studies were performed in transplant recipients. All patients had normal chest roentgenograms. If pneumonia was detected by HRCT, guided bronchoalveolar lavage was recommended. Evidence of pneumonia on chest roentgenograms during follow-up and micro-organisms detected during follow-up were regarded as documentation of pneumonia. RESULTS: Of the 188 HRCT studies, 112 (60%) showed pneumonia and 76 were normal. Documentation of pneumonia was possible in 61 cases by chest roentgenography or micro-organism detection (54%) (P < 10(-6)). Sensitivity of HRCT was 87% (88% in transplant recipients), specificity was 57% (67%), and the negative predictive value was 88% (97%). A time gain of 5 days was achieved by the additional use of HRCT compared to an exclusive use of chest roentgenography. CONCLUSION: The high frequency of inflammatory pulmonary disease after a suspicious HRCT scan (> 50%) proves that pneumonia is not excluded by a normal chest roentgenogram. Given the significantly longer duration of febrile episodes in transplant recipients, HRCT findings are particularly relevant in this subgroup. Patients with normal HRCT scans, particularly transplant recipients, have a low risk of pneumonia during follow-up. All neutropenic patients with fever of unknown origin and normal chest roentgenograms should undergo HRCT.  (+info)

Tick-borne relapsing fever imported from West Africa: diagnosis by quantitative buffy coat analysis and in vitro culture of Borrelia crocidurae. (3/299)

West African tick-borne relapsing fever (TBRF) is difficult to diagnose due to the low number of spirochetes in the bloodstream of patients. Previously, the causative microorganism, Borrelia crocidurae, had never been cultured in vitro. TBRF was rapidly diagnosed for two patients returning from western Africa with fever of unknown origin by quantitative buffy coat (QBC) analysis. Diagnosis was confirmed by intraperitoneal inoculation of blood specimens from patients into laboratory mice. In vitro experiments showed that QBC analysis may be as much as 100-fold more sensitive than thick smear. Spirochetes were also cultured from blood samples from both patients in modified Kelly's medium and were identified as B. crocidurae by partial sequencing of the PCR-amplified rrs gene.  (+info)

A case of fever following antiepileptic treatment. (4/299)

A 23-year-old female patient treated with 900 mg oxcarbazepine for complex partial seizures is presented. Good seizure control and slight fever were noted a few weeks after drug administration. Reduction of oxcarbazepine and replacement with valproate resulted in a transient normothermia. Because of fever reappearance, vigabatrin was added and valproate was gradually reduced. Seizures reappeared, but the body temperature fell below 37 degrees C. Substitution of valproate for lamotrigine resulted in seizure control but abnormal body temperature (37- 37.6 degrees C) was noted again. Repeated hospital admission for clinical and laboratory investigation before any change of treatment revealed no other abnormal findings. The patient's abnormal temperature possibly reflects a derangement of high-level temperature control.  (+info)

A double-blind comparison of empirical oral and intravenous antibiotic therapy for low-risk febrile patients with neutropenia during cancer chemotherapy. (5/299)

BACKGROUND: Among patients with fever and neutropenia during chemotherapy for cancer who have a low risk of complications, oral administration of empirical broad-spectrum antibiotics may be an acceptable alternative to intravenous treatment. METHODS: We conducted a randomized, double-blind, placebo-controlled study of patients (age, 5 to 74 years) who had fever and neutropenia during chemotherapy for cancer. Neutropenia was expected to be present for no more than 10 days in these patients, and they had to have no other underlying conditions. Patients were assigned to receive either oral ciprofloxacin plus amoxicillin-clavulanate or intravenous ceftazidime. They were hospitalized until fever and neutropenia resolved. RESULTS: A total of 116 episodes were included in each group (84 patients in the oral-therapy group and 79 patients in the intravenous-therapy group). The mean neutrophil counts at admission were 81 per cubic millimeter and 84 per cubic millimeter, respectively; the mean duration of neutropenia was 3.4 and 3.8 days, respectively. Treatment was successful without the need for modifications in 71 percent of episodes in the oral-therapy group and 67 percent of episodes in the intravenous-therapy group (difference between groups, 3 percent; 95 percent confidence interval, -8 percent to 15 percent; P=0.48). Treatment was considered to have failed because of the need for modifications in the regimen in 13 percent and 32 percent of episodes, respectively (P<0.001) and because of the patient's inability to tolerate the regimen in 16 percent and 1 percent of episodes, respectively (P<0.001). There were no deaths. The incidence of intolerance of the oral antibiotics was 16 percent, as compared with 8 percent for placebo (P=0.07). CONCLUSIONS: In hospitalized low-risk patients who have fever and neutropenia during cancer chemotherapy, empirical therapy with oral ciprofloxacin and amoxicillin-clavulanate is safe and effective.  (+info)

The incidence of ehrlichial and rickettsial infection in patients with unexplained fever and recent history of tick bite in central North Carolina. (6/299)

We examined the clinical and laboratory findings of a consecutive series of patients from central North Carolina presenting with fever and a history of tick bite within the preceding 14 days. Evidence of a tick-transmitted pathogen was detected in 16 of 35 patients enrolled over a 2-year period. Nine patients were infected with Ehrlichia chaffeensis, and 6 were infected with a spotted fever group rickettsia; 1 patient had evidence of coinfection with E. chaffeensis and a spotted fever group rickettsia. Four patients had detectable antibodies against the human granulocytic ehrlichiosis agent; however, only 2 had a 4-fold antibody titer rise without detectable antibodies against E. chaffeensis. The other 2 were thought to have cross-reacting antibodies to E. chaffeensis. We conclude that ehrlichial infections may be as common as spotted fever group rickettsial infections in febrile patients from central North Carolina with a recent history of tick bite.  (+info)

Bacteroides fragilis bacteremia and infected aortic aneurysm presenting as fever of unknown origin: diagnostic delay without routine anaerobic blood cultures. (7/299)

We report the case of a 71-year-old male with Bacteroides fragilis bactermia and infected aortic aneurysm that went undiagnosed, in part, because routine anaerobic blood cultures were not obtained. Bacteremia caused by anaerobes has been reported to be declining, and recommendations to discontinue routine anaerobic blood cultures have been implemented in some hospitals. To our knowledge, this is the first report of an anaerobic bacteremia and infection that had a delay in diagnosis due to this change in blood-culturing protocol. The potential impact of deleting anaerobic blood cultures from routine protocols is discussed.  (+info)

Unexplained fever in neonates may be associated with hepatitis B vaccine. (8/299)

AIM: To investigate whether hepatitis B vaccination has increased the number of cases of unexplained neonatal fever. METHOD: The files of all infants born from 1 January 1991 to 31 December 1992, in whom a diagnosis of "injected antibiotic" or "disease of temperature regulation" was recorded, were reviewed. Those who had unexplained fever of 38 degrees C or higher during the first three days of life were divided into two groups: infants who did not receive the hepatitis B vaccine (1991) and infants who did (1992). RESULTS: In 1992 the incidence of unexplained fever in hepatitis B vaccinated neonates was significantly higher than in the 1991 group of pre-vaccination neonates (35 out of 5819 (0.6%) vs 14 out of 5010 neonates (0.28%) respectively, p=0.013). CONCLUSIONS: The increase in the number of cases of unexplained neonatal fever seems to be associated with the introduction of routine hepatitis B vaccination on the first day of life. The possibility that an excess number of neonates will undergo unnecessary procedures and treatment to diagnose unexplained fever justifies planning a controlled study to determine whether these preliminary findings point to a significant problem.  (+info)

Fever of Unknown Origin (FUO) is a medical condition defined as a fever that remains undiagnosed after one week of inpatient evaluation or three days of outpatient evaluation, with temperatures repeatedly measuring at or above 38.3°C (101°F). The fevers can be continuous or intermittent and are often associated with symptoms such as fatigue, weight loss, and general malaise.

The causes of FUO can be broadly categorized into four groups: infections, inflammatory diseases, neoplasms (cancers), and miscellaneous conditions. Infections account for a significant proportion of cases, particularly in immunocompromised individuals. Other possible causes include connective tissue disorders, vasculitides, drug reactions, and factitious fever.

The diagnostic approach to FUO involves a thorough history and physical examination, laboratory tests, and imaging studies. The goal is to identify the underlying cause of the fever and provide appropriate treatment. In some cases, despite extensive evaluation, the cause may remain undiagnosed, and management focuses on supportive care and monitoring for any new symptoms or complications.

Fever, also known as pyrexia or febrile response, is a common medical sign characterized by an elevation in core body temperature above the normal range of 36.5-37.5°C (97.7-99.5°F) due to a dysregulation of the body's thermoregulatory system. It is often a response to an infection, inflammation, or other underlying medical conditions, and it serves as a part of the immune system's effort to combat the invading pathogens or to repair damaged tissues.

Fevers can be classified based on their magnitude:

* Low-grade fever: 37.5-38°C (99.5-100.4°F)
* Moderate fever: 38-39°C (100.4-102.2°F)
* High-grade or severe fever: above 39°C (102.2°F)

It is important to note that a single elevated temperature reading does not necessarily indicate the presence of a fever, as body temperature can fluctuate throughout the day and can be influenced by various factors such as physical activity, environmental conditions, and the menstrual cycle in females. The diagnosis of fever typically requires the confirmation of an elevated core body temperature on at least two occasions or a consistently high temperature over a period of time.

While fevers are generally considered beneficial in fighting off infections and promoting recovery, extremely high temperatures or prolonged febrile states may necessitate medical intervention to prevent potential complications such as dehydration, seizures, or damage to vital organs.

'Neoplasms, Unknown Primary' is a medical term used to describe a condition where cancerous growths or tumors are found in the body, but the origin or primary site where the cancer started cannot be identified despite extensive diagnostic tests. This situation can occur when cancer cells spread (metastasize) to other parts of the body and form new tumors before the original (primary) tumor grows large enough to be detected or causes any symptoms. In some cases, the primary tumor may regress or become dormant, making it even more challenging to locate.

Healthcare professionals use various diagnostic techniques, such as imaging tests, biopsies, and laboratory analyses of tumor tissue samples, to identify the origin of metastatic cancer. However, when these methods fail to pinpoint the primary source, the condition is classified as 'Neoplasms, Unknown Primary.' Treatment for this condition typically involves addressing the symptoms and controlling the growth of the metastatic tumors, often involving a combination of surgery, radiation therapy, chemotherapy, or targeted therapies.

Q fever is a zoonotic disease caused by the bacterium Coxiella burnetii. It is characterized by acute or chronic flu-like symptoms, pneumonia, and hepatitis. The bacteria are primarily transmitted to humans through inhalation of contaminated dust or aerosols from infected animals such as cattle, sheep, and goats. Q fever can also be transmitted through consumption of unpasteurized milk or direct contact with infected animals. It is often asymptomatic or mildly symptomatic in animals but can cause severe disease in humans.

The acute form of Q fever typically presents with sudden onset of high fever, severe headache, fatigue, muscle pain, and cough. Some patients may also develop pneumonia or hepatitis. The chronic form of the disease is less common but more serious, often affecting people with compromised immune systems. Chronic Q fever can lead to endocarditis, an infection of the inner lining of the heart, which can be life-threatening if left untreated.

Diagnosis of Q fever typically involves a combination of clinical evaluation, serological testing, and PCR (polymerase chain reaction) assays. Treatment usually involves antibiotics such as doxycycline or fluoroquinolones for several weeks to months, depending on the severity and duration of the illness. Prevention measures include avoiding contact with infected animals, wearing protective clothing and masks when handling animal products, and pasteurizing milk before consumption.

Splenic tuberculosis is a form of extrapulmonary tuberculosis (ETB), which refers to a manifestation of the disease outside of the lungs. It is caused by the bacterium Mycobacterium tuberculosis.

In splenic tuberculosis, the infection involves the spleen (an organ located in the upper left part of the abdomen that filters blood and helps fight infection). The infection can occur through the hematogenous spread (dissemination via the bloodstream) from a primary focus elsewhere in the body, such as the lungs.

The disease presents with various symptoms, including fever, fatigue, weight loss, abdominal pain, and splenomegaly (enlargement of the spleen). Diagnosis often requires a combination of clinical evaluation, imaging studies, and microbiological or histopathological confirmation. Treatment typically involves a prolonged course of multidrug antibiotics to eliminate the infection and prevent complications.

Adult-onset Still's disease (AOSD) is a rare inflammatory disorder characterized by the triad of fever, evanescent rash, and arthralgia or arthritis. It is a type of Still's disease that occurs in adults, typically between the ages of 16 and 35, but it can occur at any age.

The exact cause of AOSD is not known, but it is thought to be an autoimmune disorder, in which the body's immune system mistakenly attacks healthy tissue. The symptoms of AOSD can vary from person to person, but they often include:

* High spiking fever (often 102°F or higher) that may come and go for several weeks or months
* Salmon-pink, non-itchy rash that typically appears on the trunk and extremities and fades after a day or two
* Joint pain and swelling that can affect any joint, but is often worse in the morning and improves with activity
* Sore throat and other respiratory symptoms
* Fatigue and muscle weakness
* Swollen lymph nodes
* Liver enlargement and abnormal liver function tests
* Abnormal white blood cell count

The diagnosis of AOSD is based on a combination of clinical, laboratory and imaging findings. There are no specific diagnostic tests for AOSD, so the diagnosis is often one of exclusion, meaning that other possible causes of the symptoms must be ruled out before a diagnosis of AOSD can be made.

Treatment of AOSD typically involves the use of medications to reduce inflammation and suppress the immune system. These may include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and disease-modifying antirheumatic drugs (DMARDs) such as methotrexate or biologics like TNF inhibitors.

It is important to note that AOSD is a rare condition and its symptoms can vary from person to person, so it's essential to consult with a healthcare professional for an accurate diagnosis and treatment plan.

Histiocytic Necrotizing Lymphadenitis is a condition characterized by the inflammation and necrosis (death of tissue) of lymph nodes, caused by an abnormal proliferation and activation of histiocytes (a type of white blood cell). It is also known as Kikuchi's disease. The exact cause of this condition is unknown, but it is thought to be related to an immune response to viral infections or other antigens.

Histopathologically, it is characterized by the presence of necrotizing granulomatous inflammation with histiocytic predominance and absence of neutrophils. The condition is typically self-limiting, with symptoms resolving within a few months without specific treatment. However, in some cases, it can be associated with systemic symptoms or other autoimmune disorders.

Yellow fever is an acute viral hemorrhagic disease that's transmitted to humans through the bite of infected mosquitoes. The "yellow" in the name refers to the jaundice that can occur in some patients, resulting from liver damage caused by the virus. The disease is endemic in tropical regions of Africa and Central and South America.

The yellow fever virus is a single-stranded RNA virus that belongs to the Flaviviridae family, genus Flavivirus. It's closely related to other mosquito-borne viruses like dengue and Zika. The virus has three distinct geographical variants (West African, East African, and South American), each with different epidemiological patterns and clinical features.

The incubation period for yellow fever is typically 3 to 6 days after infection. The initial symptoms include fever, chills, headache, back pain, myalgia, and fatigue. Most patients recover after this initial phase, but around 15% of those infected enter a more severe phase characterized by high fever, jaundice, abdominal pain, vomiting, bleeding, and often rapid death within 7 to 10 days.

There is no specific treatment for yellow fever, and management is focused on supportive care, including fluid replacement, blood transfusions, and addressing any complications that arise. Prevention relies on vaccination and mosquito control measures. The yellow fever vaccine is safe and highly effective, providing immunity in 95% of those who receive it. A single dose offers lifelong protection in most individuals. Mosquito control efforts, such as reducing breeding sites and using insecticide-treated materials, can help prevent the spread of the virus in affected areas.

Typhoid fever is an acute illness caused by the bacterium Salmonella enterica serovar Typhi. It is characterized by sustained fever, headache, constipation or diarrhea, rose-colored rash (in some cases), abdominal pain, and weakness. The bacteria are spread through contaminated food, water, or direct contact with an infected person's feces. If left untreated, typhoid fever can lead to severe complications and even be fatal. It is diagnosed through blood, stool, or urine tests and treated with antibiotics. Vaccination is available for prevention.

Infection is defined medically as the invasion and multiplication of pathogenic microorganisms such as bacteria, viruses, fungi, or parasites within the body, which can lead to tissue damage, illness, and disease. This process often triggers an immune response from the host's body in an attempt to eliminate the infectious agents and restore homeostasis. Infections can be transmitted through various routes, including airborne particles, direct contact with contaminated surfaces or bodily fluids, sexual contact, or vector-borne transmission. The severity of an infection may range from mild and self-limiting to severe and life-threatening, depending on factors such as the type and quantity of pathogen, the host's immune status, and any underlying health conditions.

Hematocolpos is a medical condition where the vagina gets filled with menstrual blood due to obstruction of the lower part of the genital tract, usually caused by an imperforate hymen or a transverse septum. It is often associated with hematometra (accumulation of menstrual blood in the uterus) and hematosalpinx (presence of menstrual blood in the fallopian tubes). This condition is typically found in adolescent females and can cause pelvic pain, difficulty walking, and a palpable mass in the lower abdomen. Surgical intervention is usually required to correct the obstruction and drain the accumulated blood.

Erdheim-Chester Disease (ECD) is a rare, progressive histiocytic disorder, characterized by the accumulation of immune cells called histiocytes in various parts of the body. These histiocytes are derived from myeloid precursors and infiltrate different organs and tissues, leading to inflammation, fibrosis, and subsequent damage.

The clinical presentation of ECD is heterogeneous, with symptoms depending on the affected organs. Commonly involved sites include bones (particularly long bones), central nervous system, heart, lungs, skin, and kidneys. Symptoms may range from bone pain, fatigue, and weight loss to neurological manifestations, cardiac dysfunction, respiratory distress, and renal impairment.

Diagnosis of ECD typically involves a combination of imaging studies (such as X-rays, CT scans, MRI, or PET scans), biopsy with histopathological examination, and immunohistochemical analysis to confirm the presence of characteristic histiocytic infiltrates. Genetic testing may also be performed to identify potential genetic mutations associated with ECD.

Treatment options for ECD depend on the extent and severity of organ involvement. Current therapeutic approaches include:

1. Targeted therapy with kinase inhibitors, such as imatinib or vemurafenib, which have shown efficacy in reducing histiocytic infiltration and improving symptoms.
2. Chemotherapy using agents like cladribine or cyclophosphamide, which can help control the disease's progression.
3. Immunosuppressive therapy with corticosteroids or interferon-alpha to manage inflammation and immune response.
4. Radiation therapy for localized bone lesions or symptomatic relief.
5. Supportive care to address specific organ dysfunction, such as heart failure management or respiratory support.

Due to the rarity of ECD, treatment decisions are often made in consultation with multidisciplinary teams experienced in managing histiocytic disorders. Clinical trials evaluating novel therapeutic strategies are also essential for advancing our understanding and improving outcomes for patients with ECD.

X-ray computed tomography (CT or CAT scan) is a medical imaging method that uses computer-processed combinations of many X-ray images taken from different angles to produce cross-sectional (tomographic) images (virtual "slices") of the body. These cross-sectional images can then be used to display detailed internal views of organs, bones, and soft tissues in the body.

The term "computed tomography" is used instead of "CT scan" or "CAT scan" because the machines take a series of X-ray measurements from different angles around the body and then use a computer to process these data to create detailed images of internal structures within the body.

CT scanning is a noninvasive, painless medical test that helps physicians diagnose and treat medical conditions. CT imaging provides detailed information about many types of tissue including lung, bone, soft tissue and blood vessels. CT examinations can be performed on every part of the body for a variety of reasons including diagnosis, surgical planning, and monitoring of therapeutic responses.

In computed tomography (CT), an X-ray source and detector rotate around the patient, measuring the X-ray attenuation at many different angles. A computer uses this data to construct a cross-sectional image by the process of reconstruction. This technique is called "tomography". The term "computed" refers to the use of a computer to reconstruct the images.

CT has become an important tool in medical imaging and diagnosis, allowing radiologists and other physicians to view detailed internal images of the body. It can help identify many different medical conditions including cancer, heart disease, lung nodules, liver tumors, and internal injuries from trauma. CT is also commonly used for guiding biopsies and other minimally invasive procedures.

In summary, X-ray computed tomography (CT or CAT scan) is a medical imaging technique that uses computer-processed combinations of many X-ray images taken from different angles to produce cross-sectional images of the body. It provides detailed internal views of organs, bones, and soft tissues in the body, allowing physicians to diagnose and treat medical conditions.

Syncope is a medical term defined as a transient, temporary loss of consciousness and postural tone due to reduced blood flow to the brain. It's often caused by a drop in blood pressure, which can be brought on by various factors such as dehydration, emotional stress, prolonged standing, or certain medical conditions like heart diseases, arrhythmias, or neurological disorders.

During a syncope episode, an individual may experience warning signs such as lightheadedness, dizziness, blurred vision, or nausea before losing consciousness. These episodes usually last only a few minutes and are followed by a rapid, full recovery. However, if left untreated or undiagnosed, recurrent syncope can lead to severe injuries from falls or even life-threatening conditions related to the underlying cause.

A fatal outcome is a term used in medical context to describe a situation where a disease, injury, or illness results in the death of an individual. It is the most severe and unfortunate possible outcome of any medical condition, and is often used as a measure of the severity and prognosis of various diseases and injuries. In clinical trials and research, fatal outcome may be used as an endpoint to evaluate the effectiveness and safety of different treatments or interventions.

Gallium radioisotopes refer to specific types of gallium atoms that have unstable nuclei and emit radiation as they decay towards a more stable state. These isotopes are commonly used in medical imaging, such as in gallium scans, to help diagnose conditions like inflammation, infection, or cancer.

Gallium-67 (^67^Ga) is one of the most commonly used radioisotopes for medical purposes. It has a half-life of about 3.26 days and decays by emitting gamma rays. When administered to a patient, gallium-67 binds to transferrin, a protein that carries iron in the blood, and is taken up by cells with increased metabolic activity, such as cancer cells or immune cells responding to infection or inflammation. The distribution of gallium-67 in the body can then be visualized using a gamma camera, providing valuable diagnostic information.

A "Plasma Cell Granuloma" is a specific type of granulomatous inflammation that is characterized by the presence of numerous plasma cells. Plasma cells are white blood cells that produce antibodies, which are proteins that help the body fight off infections and diseases. In a Plasma Cell Granuloma, there is an excessive accumulation of these cells, leading to the formation of a nodular lesion or mass.

Plasma Cell Granulomas can occur in various organs, including the skin, lungs, gastrointestinal tract, and oral cavity. They are often associated with chronic inflammation, autoimmune disorders, or malignancies. The exact cause of Plasma Cell Granulomas is not always known, but they may be triggered by infections, foreign bodies, or other stimuli that induce an immune response.

Histologically, a Plasma Cell Granuloma is composed of a central area of plasma cells surrounded by a rim of lymphocytes and macrophages. The lesion may also contain multinucleated giant cells, eosinophils, and other inflammatory cells. Treatment options for Plasma Cell Granulomas depend on the location and extent of the lesion, as well as the underlying cause. Surgical excision is often curative, but medical therapy may be necessary in some cases.

Sarcoidosis is a multi-system disorder characterized by the formation of granulomas (small clumps of inflammatory cells) in various organs, most commonly the lungs and lymphatic system. These granulomas can impair the function of the affected organ(s), leading to a variety of symptoms. The exact cause of sarcoidosis is unknown, but it's thought to be an overactive immune response to an unknown antigen, possibly triggered by an infection, chemical exposure, or another environmental factor.

The diagnosis of sarcoidosis typically involves a combination of clinical evaluation, imaging studies (such as chest X-rays and CT scans), and laboratory tests (including blood tests and biopsies). While there is no cure for sarcoidosis, treatment may be necessary to manage symptoms and prevent complications. Corticosteroids are often used to suppress the immune system and reduce inflammation, while other medications may be prescribed to treat specific organ involvement or symptoms. In some cases, sarcoidosis may resolve on its own without any treatment.

A replication origin is a specific location in a DNA molecule where the process of DNA replication is initiated. It serves as the starting point for the synthesis of new strands of DNA during cell division. The origin of replication contains regulatory elements and sequences that are recognized by proteins, which then recruit and assemble the necessary enzymes to start the replication process. In eukaryotic cells, replication origins are often found in clusters, with multiple origins scattered throughout each chromosome.

Mediastinal diseases refer to a group of conditions that affect the mediastinum, which is the area in the chest separating the lungs and containing various vital structures such as the heart, esophagus, trachea, thymus gland, lymph nodes, blood vessels, and nerves. These diseases can be benign or malignant (cancerous) and may cause symptoms due to compression or invasion of surrounding tissues. Examples of mediastinal diseases include:

1. Mediastinal tumors: Abnormal growths in the mediastinum, which can be benign or malignant. Common types include thymomas, germ cell tumors, lymphomas, and neurogenic tumors.
2. Mediastinitis: Inflammation of the mediastinal tissues, often caused by infections, trauma, or complications from medical procedures.
3. Enlarged lymph nodes: Abnormal swelling of the lymph nodes in the mediastinum can be a sign of various conditions, including infections, cancer, and autoimmune disorders.
4. Mediastinal cysts: Fluid-filled sacs that develop in the mediastinum, which are usually benign but may cause symptoms due to compression or infection.
5. Aneurysms or dissections of the aorta: Abnormal weakening or tearing of the aortic wall within the mediastinum, which can lead to life-threatening complications if not treated promptly.
6. Esophageal diseases: Conditions affecting the esophagus, such as tumors, strictures, or motility disorders, may present with symptoms related to the mediastinum.
7. Thyroid disorders: Enlargement of the thyroid gland (goiter) can extend into the mediastinum and cause compression symptoms.
8. Hematomas or effusions: Accumulation of blood (hematoma) or fluid (effusion) in the mediastinal space due to trauma, surgery, or other underlying conditions.

Early diagnosis and appropriate treatment are crucial for managing mediastinal diseases and improving patient outcomes.

Retrospective studies, also known as retrospective research or looking back studies, are a type of observational study that examines data from the past to draw conclusions about possible causal relationships between risk factors and outcomes. In these studies, researchers analyze existing records, medical charts, or previously collected data to test a hypothesis or answer a specific research question.

Retrospective studies can be useful for generating hypotheses and identifying trends, but they have limitations compared to prospective studies, which follow participants forward in time from exposure to outcome. Retrospective studies are subject to biases such as recall bias, selection bias, and information bias, which can affect the validity of the results. Therefore, retrospective studies should be interpreted with caution and used primarily to generate hypotheses for further testing in prospective studies.

Polyarteritis nodosa (PAN) is a rare, systemic necrotizing vasculitis that affects medium-sized and small muscular arteries. It is characterized by inflammation and damage to the walls of the arteries, leading to the formation of microaneurysms (small bulges in the artery wall) and subsequent narrowing or complete occlusion of the affected vessels. This can result in tissue ischemia (reduced blood flow) and infarction (tissue death), causing a wide range of clinical manifestations that vary depending on the organs involved.

The exact cause of PAN remains unclear, but it is believed to involve an autoimmune response triggered by various factors such as infections or exposure to certain drugs. The diagnosis of PAN typically requires a combination of clinical findings, laboratory tests, and imaging studies, often supported by histopathological examination of affected tissues. Treatment usually involves the use of immunosuppressive medications to control inflammation and prevent further damage to the arteries and organs.

Rheumatic fever is a systemic inflammatory disease that may occur following an untreated Group A streptococcal infection, such as strep throat. It primarily affects children between the ages of 5 and 15, but it can occur at any age. The condition is characterized by inflammation in various parts of the body, including the heart (carditis), joints (arthritis), skin (erythema marginatum, subcutaneous nodules), and brain (Sydenham's chorea).

The onset of rheumatic fever usually occurs 2-4 weeks after a streptococcal infection. The exact cause of the immune system's overreaction leading to rheumatic fever is not fully understood, but it involves molecular mimicry between streptococcal antigens and host tissues.

The Jones Criteria are used to diagnose rheumatic fever, which include:

1. Evidence of a preceding streptococcal infection (e.g., positive throat culture or rapid strep test, elevated or rising anti-streptolysin O titer)
2. Carditis (heart inflammation), including new murmurs or changes in existing murmurs, electrocardiogram abnormalities, or evidence of heart failure
3. Polyarthritis (inflammation of multiple joints) – typically large joints like the knees and ankles, migratory, and may be associated with warmth, swelling, and pain
4. Erythema marginatum (a skin rash characterized by pink or red, irregularly shaped macules or rings that blanch in the center and spread outward)
5. Subcutaneous nodules (firm, round, mobile lumps under the skin, usually over bony prominences)
6. Sydenham's chorea (involuntary, rapid, irregular movements, often affecting the face, hands, and feet)

Treatment of rheumatic fever typically involves antibiotics to eliminate any residual streptococcal infection, anti-inflammatory medications like corticosteroids or nonsteroidal anti-inflammatory drugs (NSAIDs) to manage symptoms and prevent long-term heart complications, and secondary prophylaxis with regular antibiotic administration to prevent recurrent streptococcal infections.

Lymphatic diseases refer to a group of conditions that affect the lymphatic system, which is an important part of the immune and circulatory systems. The lymphatic system consists of a network of vessels, organs, and tissues that help to transport lymph fluid throughout the body, fight infection, and remove waste products.

Lymphatic diseases can be caused by various factors, including genetics, infections, cancer, and autoimmune disorders. Some common types of lymphatic diseases include:

1. Lymphedema: A condition that causes swelling in the arms or legs due to a blockage or damage in the lymphatic vessels.
2. Lymphoma: A type of cancer that affects the lymphatic system, including Hodgkin's and non-Hodgkin's lymphoma.
3. Infections: Certain bacterial and viral infections can affect the lymphatic system, such as tuberculosis, cat-scratch disease, and HIV/AIDS.
4. Autoimmune disorders: Conditions such as rheumatoid arthritis, lupus, and scleroderma can cause inflammation and damage to the lymphatic system.
5. Congenital abnormalities: Some people are born with abnormalities in their lymphatic system, such as malformations or missing lymph nodes.

Symptoms of lymphatic diseases may vary depending on the specific condition and its severity. Treatment options may include medication, physical therapy, surgery, or radiation therapy. It is important to seek medical attention if you experience symptoms of a lymphatic disease, as early diagnosis and treatment can improve outcomes.

A tilt-table test is a diagnostic procedure used to evaluate symptoms of syncope (fainting) or near-syncope. It measures your body's cardiovascular response to changes in position. During the test, you lie on a table that can be tilted to change the angle of your body from horizontal to upright. This simulates what happens when you stand up from a lying down position.

The test monitors heart rate, blood pressure, and oxygen levels while you're in different positions. If you experience symptoms like dizziness or fainting during the test, these can provide clues about the cause of your symptoms. The test is used to diagnose conditions like orthostatic hypotension (a sudden drop in blood pressure when standing), vasovagal syncope (fainting due to an overactive vagus nerve), and other heart rhythm disorders.

Molecular sequence data refers to the specific arrangement of molecules, most commonly nucleotides in DNA or RNA, or amino acids in proteins, that make up a biological macromolecule. This data is generated through laboratory techniques such as sequencing, and provides information about the exact order of the constituent molecules. This data is crucial in various fields of biology, including genetics, evolution, and molecular biology, allowing for comparisons between different organisms, identification of genetic variations, and studies of gene function and regulation.

Hepatomegaly is a medical term that refers to an enlargement of the liver beyond its normal size. The liver is usually located in the upper right quadrant of the abdomen and can be felt during a physical examination. A healthcare provider may detect hepatomegaly by palpating (examining through touch) the abdomen, noticing that the edge of the liver extends past the lower ribcage.

There are several possible causes for hepatomegaly, including:
- Fatty liver disease (both alcoholic and nonalcoholic)
- Hepatitis (viral or autoimmune)
- Liver cirrhosis
- Cancer (such as primary liver cancer, metastatic cancer, or lymphoma)
- Infections (e.g., bacterial, fungal, or parasitic)
- Heart failure and other cardiovascular conditions
- Genetic disorders (e.g., Gaucher's disease, Niemann-Pick disease, or Hunter syndrome)
- Metabolic disorders (e.g., glycogen storage diseases, hemochromatosis, or Wilson's disease)

Diagnosing the underlying cause of hepatomegaly typically involves a combination of medical history, physical examination, laboratory tests, and imaging studies like ultrasound, CT scan, or MRI. Treatment depends on the specific cause identified and may include medications, lifestyle changes, or, in some cases, surgical intervention.

A biopsy is a medical procedure in which a small sample of tissue is taken from the body to be examined under a microscope for the presence of disease. This can help doctors diagnose and monitor various medical conditions, such as cancer, infections, or autoimmune disorders. The type of biopsy performed will depend on the location and nature of the suspected condition. Some common types of biopsies include:

1. Incisional biopsy: In this procedure, a surgeon removes a piece of tissue from an abnormal area using a scalpel or other surgical instrument. This type of biopsy is often used when the lesion is too large to be removed entirely during the initial biopsy.

2. Excisional biopsy: An excisional biopsy involves removing the entire abnormal area, along with a margin of healthy tissue surrounding it. This technique is typically employed for smaller lesions or when cancer is suspected.

3. Needle biopsy: A needle biopsy uses a thin, hollow needle to extract cells or fluid from the body. There are two main types of needle biopsies: fine-needle aspiration (FNA) and core needle biopsy. FNA extracts loose cells, while a core needle biopsy removes a small piece of tissue.

4. Punch biopsy: In a punch biopsy, a round, sharp tool is used to remove a small cylindrical sample of skin tissue. This type of biopsy is often used for evaluating rashes or other skin abnormalities.

5. Shave biopsy: During a shave biopsy, a thin slice of tissue is removed from the surface of the skin using a sharp razor-like instrument. This technique is typically used for superficial lesions or growths on the skin.

After the biopsy sample has been collected, it is sent to a laboratory where a pathologist will examine the tissue under a microscope and provide a diagnosis based on their findings. The results of the biopsy can help guide further treatment decisions and determine the best course of action for managing the patient's condition.

Sensitivity and specificity are statistical measures used to describe the performance of a diagnostic test or screening tool in identifying true positive and true negative results.

* Sensitivity refers to the proportion of people who have a particular condition (true positives) who are correctly identified by the test. It is also known as the "true positive rate" or "recall." A highly sensitive test will identify most or all of the people with the condition, but may also produce more false positives.
* Specificity refers to the proportion of people who do not have a particular condition (true negatives) who are correctly identified by the test. It is also known as the "true negative rate." A highly specific test will identify most or all of the people without the condition, but may also produce more false negatives.

In medical testing, both sensitivity and specificity are important considerations when evaluating a diagnostic test. High sensitivity is desirable for screening tests that aim to identify as many cases of a condition as possible, while high specificity is desirable for confirmatory tests that aim to rule out the condition in people who do not have it.

It's worth noting that sensitivity and specificity are often influenced by factors such as the prevalence of the condition in the population being tested, the threshold used to define a positive result, and the reliability and validity of the test itself. Therefore, it's important to consider these factors when interpreting the results of a diagnostic test.

Rift Valley Fever (RVF) is a viral zoonotic disease that primarily affects animals, but can also have serious consequences for humans. It is caused by the Rift Valley Fever virus (RVFV), which belongs to the family Bunyaviridae and the genus Phlebovirus.

The disease is transmitted through the bite of infected mosquitoes or through contact with the blood, milk, or other bodily fluids of infected animals such as cattle, sheep, goats, and camels. In humans, RVF can cause a range of symptoms, from mild fever and headache to severe complications such as retinitis, encephalitis, and hemorrhagic fever, which can be fatal in some cases.

RVF is endemic in parts of Africa, particularly in the Rift Valley region, and has also been reported in the Arabian Peninsula. It poses a significant public health and economic threat to affected regions due to its potential to cause large-scale outbreaks with high mortality rates in both animals and humans. Prevention and control measures include vaccination of animals, vector control, and avoidance of mosquito bites.

Neutropenia is a condition characterized by an abnormally low concentration (less than 1500 cells/mm3) of neutrophils, a type of white blood cell that plays a crucial role in fighting off bacterial and fungal infections. Neutrophils are essential components of the innate immune system, and their main function is to engulf and destroy microorganisms that can cause harm to the body.

Neutropenia can be classified as mild, moderate, or severe based on the severity of the neutrophil count reduction:

* Mild neutropenia: Neutrophil count between 1000-1500 cells/mm3
* Moderate neutropenia: Neutrophil count between 500-1000 cells/mm3
* Severe neutropenia: Neutrophil count below 500 cells/mm3

Severe neutropenia significantly increases the risk of developing infections, as the body's ability to fight off microorganisms is severely compromised. Common causes of neutropenia include viral infections, certain medications (such as chemotherapy or antibiotics), autoimmune disorders, and congenital conditions affecting bone marrow function. Treatment for neutropenia typically involves addressing the underlying cause, administering granulocyte-colony stimulating factors to boost neutrophil production, and providing appropriate antimicrobial therapy to prevent or treat infections.

Splenomegaly is a medical term that refers to an enlargement or expansion of the spleen beyond its normal size. The spleen is a vital organ located in the upper left quadrant of the abdomen, behind the stomach and below the diaphragm. It plays a crucial role in filtering the blood, fighting infections, and storing red and white blood cells and platelets.

Splenomegaly can occur due to various underlying medical conditions, including infections, liver diseases, blood disorders, cancer, and inflammatory diseases. The enlarged spleen may put pressure on surrounding organs, causing discomfort or pain in the abdomen, and it may also lead to a decrease in red and white blood cells and platelets, increasing the risk of anemia, infections, and bleeding.

The diagnosis of splenomegaly typically involves a physical examination, medical history, and imaging tests such as ultrasound, CT scan, or MRI. Treatment depends on the underlying cause and may include medications, surgery, or other interventions to manage the underlying condition.

**Hemorrhagic fevers, viral** are a group of severe, potentially fatal illnesses caused by viruses that affect the body's ability to regulate its blood vessels and clotting abilities. These viruses belong to several different families including *Filoviridae* (e.g., Ebola, Marburg), *Arenaviridae* (e.g., Lassa, Machupo), *Bunyaviridae* (e.g., Hantavirus, Crimean-Congo hemorrhagic fever virus) and *Flaviviridae* (e.g., Dengue, Yellow Fever).

The initial symptoms are non-specific and include sudden onset of fever, fatigue, muscle aches, joint pains, headache, and vomiting. As the disease progresses, it may lead to capillary leakage, internal and external bleeding, and multi-organ failure resulting in shock and death in severe cases.

The transmission of these viruses can occur through various means depending on the specific virus. For example, some are transmitted via contact with infected animals or their urine/feces (e.g., Hantavirus), others through insect vectors like ticks (Crimean-Congo hemorrhagic fever) or mosquitoes (Dengue, Yellow Fever), and yet others through direct contact with infected body fluids (Ebola, Marburg).

There are no specific treatments for most viral hemorrhagic fevers. However, some experimental antiviral drugs have shown promise in treating certain types of the disease. Supportive care, such as maintaining blood pressure, replacing lost fluids and electrolytes, and managing pain, is critical to improving outcomes. Prevention measures include avoiding areas where the viruses are common, using personal protective equipment when caring for infected individuals or handling potentially contaminated materials, and controlling insect vectors.

Sources: Centers for Disease Control and Prevention (CDC), World Health Organization (WHO).

Lassa fever is an acute viral hemorrhagic fever caused by the Lassa virus. It is primarily transmitted to humans through contact with infected rodents or their excreta, and it can also spread from person to person via bodily fluids. The symptoms of Lassa fever typically include fever, sore throat, muscle pain, chest pain, headache, and vomiting. In severe cases, the disease can cause bleeding from the mouth and nose, as well as complications such as deafness and encephalitis. Lassa fever is endemic to West Africa, particularly in Nigeria, Guinea, Liberia, and Sierra Leone.

Phylogeny is the evolutionary history and relationship among biological entities, such as species or genes, based on their shared characteristics. In other words, it refers to the branching pattern of evolution that shows how various organisms have descended from a common ancestor over time. Phylogenetic analysis involves constructing a tree-like diagram called a phylogenetic tree, which depicts the inferred evolutionary relationships among organisms or genes based on molecular sequence data or other types of characters. This information is crucial for understanding the diversity and distribution of life on Earth, as well as for studying the emergence and spread of diseases.

Vasculitis is a group of disorders characterized by inflammation of the blood vessels, which can cause changes in the vessel walls including thickening, narrowing, or weakening. These changes can restrict blood flow, leading to organ and tissue damage. The specific symptoms and severity of vasculitis depend on the size and location of the affected blood vessels and the extent of inflammation. Vasculitis can affect any organ system in the body, and its causes can vary, including infections, autoimmune disorders, or exposure to certain medications or chemicals.

Fever of unknown origin (FUO) refers to a condition in which the patient has an elevated temperature (fever) but, despite ... Bartonella infections are also known to cause fever of unknown origin. Human herpes viruses are a common cause of fever of ... Cancer can also cause fever of unknown origin. This is thought to be due to release of pyrogenic cytokines from cancer cells as ... Auto-inflammatory and auto-immune disorders account for approximately 5-32% of fevers of unknown origin. These can be ...
Fever of unknown origin (FUO) was defined in 1961 by Petersdorf and Beeson as the following: (1) a temperature greater than ... encoded search term (Fever of Unknown Origin (FUO)) and Fever of Unknown Origin (FUO) What to Read Next on Medscape ... Key features of fever of unknown origin (FUO), also known as pyrexia of unknown origin (PUO), are as follows:. * Unexplained ... Fever and Fever of Unknown Origin: Review, Recent Advances, and Lingering Dogma. Open Forum Infectious Diseases. 2020 May 02. 7 ...
Fever of unknown origin (FUO) refers to elevated body temperature for which a cause is not found after basic medical evaluation ... A fever of unknown origin (FUO) is a fever of at least 101°F (38.3°C) that lasts for more than three weeks or occurs frequently ... Once a fever lasts long enough to be classified as a fever of unknown origin, your doctor may run some tests to determine the ... Many fevers of unknown origin are impossible to diagnose, and they can resolve without treatment. Nevertheless, a fever lasting ...
... Infection. 2003 Dec;31(6):417-20. doi: 10.1007/s15010-003-3040-6. ... Background: The etiology of fever of unknown origin (FUO) includes primarily infectious, collagen-vascular and neoplastic ...
... , Fever of Undetermined Origin, Prolonged Febrile Illness, Prolonged Fever. ... Fever of Unknown Origin. Fever of Unknown Origin Aka: Fever of Unknown Origin, Fever of Undetermined Origin, Prolonged Febrile ... Immune-Deficient Fever of Unknown Origin *Daily or Intermittent Fever ,= 38.3 C (101 F) ... HIV-Associated Fever of Unknown Origin *Daily or Intermittent Fever ,= 38.3 C (101 F) ...
Before the fever, I had cold and cough. ,b,The fever comes mostly in the evenings and sometimes in the day,/b,. I do not feel ... Now the fever has come down to 99. But I feel feverish along with a slight headache. But breathlessness and sweating is still ... What is the cause of fever? How can I get rid of breathlessness and sweating? I feel very weak. ... From the past 25 days I have fever up to 100 degree Celsius. ... What is the cause of fever of unknown origin?. Answered by: Dr ...
Classic fever of unknown origin: Analysis of a cohort of 87 patients according to the definition with qualitative study ... Inicio Medicina Clínica (English Edition) Classic fever of unknown origin: Analysis of a cohort of 87 patients according t... ... The aim of this study was to evaluate the characteristics of fever of unknown origin (FUO) according to the definition with ... Table 3. Clinical characteristics of patients with fever of unknown origin according to diagnostic categories. ...
The authors were the first to define a fever of unknown origin as a persistent fever greater than 101ºF, an illness of greater ... N is an FUO-medical parlance for a fever of unknown origin-and by definition, if her disease could be diagnosed by something as ... On the other hand … my mind drifted back to a case of psychogenic fever of unknown origin in a woman one of my partners ... Diagnosis Can Be Elusive for Fever of Unknown Origin. Charles Radis, DO , Issue: March 2016 , March 15, 2016. ...
Fever of unknown origin refers generally to any persistent fever (ie, that does not resolve spontaneously or with empirical ...
... the use of a pre-defined Minimal Diagnostic Work-up to qualify a fever as FUO seems to correlate with a lower prevalence of ... The differential diagnosis of Fever of Unknown Origin (FUO) is very extensive, and includes infectious diseases (ID), neoplasms ... From: Fever of unknown origin (FUO): which are the factors influencing the final diagnosis? A 2005-2015 systematic review ...
Fever of unknown origin (FUO), also known as pyrexia of unknown origin, is commonly defined according to the Petersdorf ... 18F-FDG PET-CT versus contrast enhanced CT for the diagnosis of fever of unknown origin. ... criteria as fever ≥38.3° (101 Fahrenheit) lasting ≥3 weeks that remains undiagnosed after 1 week of investigations [1]. The ...
Fever of unknown origin (FUO) was defined in 1961 by Petersdorf and Beeson as the following: (1) a temperature greater than ... encoded search term (Fever of Unknown Origin) and Fever of Unknown Origin What to Read Next on Medscape ... Fever of Unknown Origin. Updated: Sep 14, 2015 * Author: Kirk M Chan-Tack, MD; Chief Editor: Michael Stuart Bronze, MD more... ... Hao R, Yuan L, Kan Y, Li C, Yang J. Diagnostic performance of 18F-FDG PET/CT in patients with fever of unknown origin: a meta- ...
Fever of Unknown Origin (FUO) - Etiology, pathophysiology, symptoms, signs, diagnosis & prognosis from the MSD Manuals - ... Some Causes of Fever of Unknown Origin (FUO) Some Causes of Fever of Unknown Origin (FUO) ). For example, housebound older ... Some Causes of Fever of Unknown Origin (FUO) Some Causes of Fever of Unknown Origin (FUO) ): ... Some Causes of Fever of Unknown Origin (FUO) Some Causes of Fever of Unknown Origin (FUO) ). ...
An interesting case of fever of unknown origin on MedShr ... MedShr - An interesting case of fever of unknown origin. * ...
What is Fever of Unknown Origin (FUO): was recognized in the 1960s, in adults and Childrens is defined as a temperature higher ...
Feline Fever of Unknown Origin Diagnostic Plan Print Section If case is chronic, virus isolation can be omitted if desired. If ... See Small Animal Internal Medicine, 5th Edition, 2014, Nelson RW and Couto CG; Chapter 88: Fever of Unknown Origin, pages 1279- ... and some blood parasite causes of acute fever of unknown origin, as well as certain inflammatory changes which may assist in ... of illness are best detected acutely and most are unlikely to be detected in a patient with a chronic fever of unknown origin. ...
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... to remember about Later Stage Diagnostic Tests In Fever Of Unknown Origin ... Recurrent Fever In Fever Of Unknown Origin Mnemonic June 3, 2023. Regimens For The Treatment Of Fever : Mnemonic May 10, 2023. ... Epidemiology of Fever Of Unknown Origin Mnemonic June 2, 2023. First Stage Diagnostic Tests In Fever Of Unknown Origin Mnemonic ... Later Stage Diagnostic Tests In Fever Of Unknown Origin Mnemonic. Home - Medical Mnemonics - Later Stage Diagnostic Tests In ...
Fever of unknown origin (FUO) is a fever with no clear cause even after testing for at least 1 to 2 weeks. A fever is often ... Fever of Unknown Origin. (FUO; Pyrexia of Unknown Origin). by Ricker Polsdorfer, MD ... Fever of unknown origin (FUO) in adults. EBSCO DynaMed website. Available at:https://www.dynamed.com/approach-to/fever-of- ... Review of fever of unknown origin: clinical approach. can be found in Am J Med 2015 Oct;128(10):1138. Accessed at: https://www. ...
Fever of unknown origin (FUO) is a fever with no clear cause even after testing for at least 1 to 2 weeks. A fever is often ... Fever of Unknown Origin. (FUO; Pyrexia of Unknown Origin). by Ricker Polsdorfer, MD ... Fever of unknown origin (FUO) in adults. EBSCO DynaMed website. Available at:https://www.dynamed.com/approach-to/fever-of- ... Review of fever of unknown origin: clinical approach. can be found in Am J Med 2015 Oct;128(10):1138. Accessed at: https://www. ...
Etiology of Fever of Unknown Origin in Children. View Table,,Download (.pdf). Table 228-1. Etiology of Fever of Unknown Origin ... Two-thirds of children who now present with fever of unknown origin resolve their fever without determination of a cause, in ... Fever of Unknown Origin." Rudolphs Pediatrics, 22e Rudolph CD, Rudolph AM, Lister GE, First LR, Gershon AA. Rudolph C.D., & ... Fever of Unknown Origin. In: Rudolph CD, Rudolph AM, Lister GE, First LR, Gershon AA. Rudolph C.D., & Rudolph A.M., & Lister G. ...
Serious illnesses of unknown origin.. Top of Page. How quickly do PHEICs have to be reported?. In the U.S., the federal ... These might include things like cholera, plague, or a viral hemorrhagic fever, like Ebola. ...
Miller, Ryan and Allen, Richard, "Fever of Unknown Origin: A Grave Diagnosis" (2022). South Atlantic Division Research Day 2022 ...
Fever of unknown origin. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennetts Principles and Practice of ... What other symptoms do you have, such as shortness of breath, fever, general ill feeling, or muscle aches? ...
Mesenteric panniculitis as a possible cause of fever of unknown origin. Mesenteric panniculitis as a possible cause of fever of ... This case suggests that mesenteric panniculitis merits consideration in the differential diagnosis of fever of unknown origin. ... unknown origin. Lombana, Gregory Richard; Patel, Nisha Ajay; High, Kevin P. Afiliación *Lombana GR; General Surgery, Wake ... The fevers resolved over several weeks, and no further episodes have occurred since discharge. ...
Dive into the research topics of Relationships between causes of fever of unknown origin and inflammatory markers: A ... Relationships between causes of fever of unknown origin and inflammatory markers: A multicenter collaborative retrospective ... Relationships between causes of fever of unknown origin and inflammatory markers: A multicenter collaborative retrospective ... Relationships between causes of fever of unknown origin and inflammatory markers: A multicenter collaborative retrospective ...
Fever of Unknown Origin / diagnosis * Giant Cell Arteritis / diagnosis* * Giant Cell Arteritis / pathology ...
Brucellosis as the Cause of Pediatric Fever of Unknown Origin (Articles) Elda Skenderi, Admir Sulovari, Alberta Shkembi, Nilsa ... Amebiasis as the Cause of Pediatric Fever of Unknown Origin (Articles) Elda Skenderi, Admir Sulovari, Gjeorgjina Kuli-Lito, ... The Role of Mediterranean Spotted Fever in the Spectrum of Pediatric Fever with Rashes (Articles) ... Fever induced by isoniazid (Articles) Pinar Tosun Tasar, Sevnaz Sahin, Niyazi Bozkurt, Abdullah Sayıner, Soner Duman, Fehmi ...
Fever of unknown origin and incidence of cancer. Søgaard, K. K., Farkas, D. K., Leisner, M. Z., Schmidt, S. A. J., Lash, T. L. ... Fever of Unknown Origin: A Validation Study of Danish ICD-10 Diagnosis Codes. Gedebjerg, A., Kirk, K. F., Lassen, P. O., Farkas ...
  • Approximately 2 weeks after initial HIV infection, with viral loads being high, an acute retroviral syndrome can present with fevers, rash and mono-like symptoms. (wikipedia.org)
  • Epidemiology of the acute fevers of unknown origin in South Vietnam: effect of laboratory support upon clinical diagnosis. (nih.gov)
  • In most cases, fever is a sign of acute infectious disease and subsides spontaneously without the need for specific intervention [ 1 ]. (biomedcentral.com)
  • Although most of these febrile illnesses are due to acute or chronic infections, other disease categories should be considered in some cases as the primary cause of fever. (biomedcentral.com)
  • These endemic mycoses may also present with pulmonary symptoms or extra-pulmonary symptoms such as B symptoms (such as fevers, chills, night sweats, unexplained weight loss). (wikipedia.org)
  • I remember one evening getting fever and chills, which is what prompted me to take my temperature with an ear thermometer. (cancer.org)
  • A 51-year-old female with a past medical history of deep vein thrombosis (DVT), pulmonary embolism, and well controlled diabetes mellitus type 2 (hemoglobin A1c 6.1%) presented after several days of worsening chest pain, low-grade fevers, and chills. (hindawi.com)
  • This was done with Mrs. Brown and she came back stating she felt much better and that the fever and night sweats had cleared. (trinitymedassoc.com)
  • The cancer types most associated with fever of unknown origin include renal cell carcinoma, lymphoma, liver cancer, ovarian cancer atrial myxoma and Castleman disease. (wikipedia.org)
  • Although most neoplasms can present with fever, malignant lymphoma is by far the most common diagnosis of FUO among the neoplasms. (wikipedia.org)
  • In patients with tumor fever, diseases commonly detected by 18 F-FDG PET include Hodgkin's disease and aggressive non-Hodgkin's lymphoma but also colorectal cancer and sarcoma. (snmjournals.org)
  • Fever of unknown origin caused by hemophagocytic lymphohistiocytosis associated with diffuse large B-cell lymphoma. (bvsalud.org)
  • A prospective multicenter study on fever of unknown origin: the yield of a structured diagnostic protocol. (medscape.com)
  • https://journals.lww.com/md-journal/Fulltext/2007/01000/A_Prospective_Multicenter_Study_on_Fever_of.3.aspx http://www.ncbi.nlm.nih.gov/pubmed/17220753?tool=bestpractice.com [5] De Kleijn EM, Vandenbroucke JP, van der Meer JW. (bmj.com)
  • Other symptoms of infectious mononucleosis vary with age with middle aged adults and the elderly more likely to have a longer duration of fever and leukopenia, and younger adults and adolescents more likely to have splenomegaly, pharyngitis and lymphadenopathy. (wikipedia.org)
  • The newly active immune system often has an exaggerated response against opportunistic pathogens leading to a fever and other inflammatory symptoms. (wikipedia.org)
  • So far I don't have any other symptoms aside from this crazy ongoing fever (99's and ocassional 100) for weeks now. (cancer.org)
  • Fever of unknown origin (FUO) is body temperature ≥ 38.3 ° C ( ≥ 101° F) rectally that does not result from transient and self-limited illness, rapidly fatal illness, or disorders with clear-cut localizing symptoms or signs or with abnormalities on common tests such as chest x-ray, urinalysis, or blood cultures. (msdmanuals.com)
  • Though it's not always ideal, sometimes an initial course of a broad spectrum antibiotic is given to see if this clears the fever and other symptoms or whether a further work-up will be needed. (trinitymedassoc.com)
  • Sometimes, other accompanying symptoms make it clear what the cause of fever is. (infectiousdiseasescenter.com)
  • What other symptoms do you have, such as shortness of breath, fever, general ill feeling, or muscle aches? (medlineplus.gov)
  • Classic symptoms of MERS include cough, fever, and shortness of breath. (nvic.org)
  • Exotic Vacation themed gift box includes these mini microbes: Gangrene, Malaria, West Nile, Dengue Fever, and Zombie Virus. (giantmicrobes.com)
  • Dengue fever is a tropical disease endemic to more than 100 countries. (giantmicrobes.com)
  • The origin of the name Dengue is unknown, but is thought to derive from the Swahili "ka-dinga pepo" (or "disease of the devil") corrupted to the Spanish word "dengue" which described the "fastidious" gait exhibited by sufferers as they walk. (giantmicrobes.com)
  • Sporadic outbreaks of chikungunya fever are currently reported nationwide (April 2022). (una.py)
  • Soon she complained of extreme weakness, had sporadic fevers and could not urinate. (cdc.gov)
  • The initial health alert reported illness in 59 individuals with symptom onset dates beginning December 12, 2019 that included shortness of breath and fever. (nvic.org)
  • On January 30, 2020, the World Health Organization (WHO) declared the outbreak a "Public Health Emergency of International Concern" with health officials reporting that the origin of the virus was likely an unsanitary food market in Wuhan City, China. (nvic.org)
  • Fever of unknown origin (FUO) was originally defined as recurrent fever of 38.3°C or higher, lasting 2-3 wk or longer, and undiagnosed after 1 wk of hospital evaluation. (snmjournals.org)
  • Basically, FUO's are described as a recurrent fever of 101 or greater over a course of 3 or more weeks with no obvious source despite an adequate workup to find one. (trinitymedassoc.com)
  • The spectrum of disease seen in this series differs significantly from that reported in adults with fevers of unknown origin. (jamanetwork.com)
  • A majority of diseases that cause kidney failure and related cardiovascular complications among adults have their origins in childhood. (nih.gov)
  • 2. [Still's syndrome in adults as one of the causes of fever of unknown origin]. (nih.gov)
  • http://www.ncbi.nlm.nih.gov/pubmed/9413425?tool=bestpractice.com [6] Knockaert DC, Vanderschueren S, Blockmans D. Fever of unknown origin in adults: 40 years on. (bmj.com)
  • 2021). Fever of Unknown Origin. (dellsystem.me)
  • And that is what we have been seeing since October 2021, when five children with hepatitis of unknown cause were first identified. (keepkidshealthy.com)
  • Thromboembolic disease (i.e. pulmonary embolism, deep venous thrombosis) occasionally shows fever. (wikipedia.org)
  • New individual research projects will study several other health conditions important in Africa, including neurological disorders, respiratory diseases, fevers of unknown origin, tuberculosis and African sleeping sickness. (nih.gov)
  • BackgroundFever of unknown origin (FUO) is a group of diseases with heterogeneous complex causes that are misdiagnosed or have delayed diagnoses. (doaj.org)
  • Among the different etiologies for fever of unknown origin in children, infectious diseases are the most frequent final diagnosis, followed by autoimmune diseases and malignancies. (biomedcentral.com)
  • Autoinflammatory diseases are relatively rare among children and are frequently overlooked as differential diagnoses for fever of unknown origin. (biomedcentral.com)
  • Once the possibility of a particular autoimmune disease is considered by physicians, the diagnosis might be easily made by a genetic approach because many of autoinflammatory diseases are of monogenic origin. (biomedcentral.com)
  • This short review discusses the clinical and laboratory features of familial Mediterranean fever and systemic juvenile idiopathic arthritis, as representative illnesses of monogenic and polygenic autoinflammatory diseases, respectively. (biomedcentral.com)
  • In addition to infectious diseases, malignancies and autoimmune diseases are the two other major categories of illness responsible for fever of unknown origin (FUO). (biomedcentral.com)
  • In this short review, the author describes the two autoinflammatory diseases most prevalent among children, namely, familial Mediterranean fever (FMF) and systemic juvenile idiopathic arthritis (sJIA), and discusses the role of physicians in employing a multi-faceted approach to reach an early diagnosis and timely application of the appropriate therapeutic interventions to avoid an unnecessary diagnostic odyssey. (biomedcentral.com)
  • This young woman with a new, prolonged fever of unknown etiology has a longstanding history of polyarthritis. (medscape.com)
  • The choice of medications administered to patients depends on the etiology of the fever of unknown origin (FUO). (medscape.com)
  • The syndrome of fever of unknown origin ( FUO ) was defined in 1961 by Petersdorf and Beeson as the following: (1) a temperature greater than 38.3°C (101°F) on several occasions, (2) more than 3 weeks' duration of illness, and (3) failure to reach a diagnosis despite one week of inpatient investigation. (wchcmr.org)
  • It should be included in the differential diagnosis of fever of unknown origin and any lymphadenopathy syndrome. (aafp.org)
  • This technique appears to be particularly useful in the evaluation of osteomyelitis, infected prostheses, fever of unknown origin, and acquired immunodeficiency syndrome. (diagnosticimaging.com)
  • Chikungunya fever is a viral disease first described in 1952. (una.py)
  • We present the case of a young man with chikungunya fever in the subacute phase which presented at hospital admission as fever of unknown origin. (una.py)
  • Bartonella infections are also known to cause fever of unknown origin. (wikipedia.org)
  • Following these guidelines will eliminate from consideration most short-lived viral pyrexias and other benign transient causes of fever. (snmjournals.org)
  • These might include things like cholera, plague, or a viral hemorrhagic fever, like Ebola. (cdc.gov)
  • In young children with fever without source (FWS), one challenge is to identify those with a severe bacterial infection (SBI) among a majority suffering from a benign viral infection. (bmj.com)
  • 不明原因发热(fever of unknown origin, FUO)定义为持续 3 周以上体温>38.3°C(>100.9°F)数次,尽管在医院评估了至 (bmj.com)
  • The primary question is whether the information at hand can tell you if she most likely has fever due to the SLE or due to superimposed infection, a common problem in active SLE. (medscape.com)
  • Human herpes viruses are a common cause of fever of unknown origin with one study showing Cytomegalovirus, Epstein-Barr virus, human herpesvirus 6 (HHV-6), human herpesvirus 7 (HHV-7) being present in 15%, 10%, 14% and 4.8% respectively with 10% of people presenting with co-infection (infection with two or more human herpes viruses). (wikipedia.org)
  • causes of fever of unknown origin are usually not associated with HIV infection. (wikipedia.org)
  • c) Fever of unknown origin - for identification of the source of infection (which could be due to septic emboli). (acr.org)
  • Objective The identification of severe bacterial infection (SBI)in children with fever without source (FWS) remains a diagnostic problem. (bmj.com)
  • Experts are investigating cases of severe hepatitis of unknown cause in children around the world. (keepkidshealthy.com)
  • 19. [Fever of unknown origin in rheumatology]. (nih.gov)
  • Rare differential diagnosis of fever of unknown origin]. (nih.gov)
  • Do you think this fever of unknown origin could be a result of systemic lupus erythematosus (SLE) or more likely from another cause? (medscape.com)
  • From Prolonged Febrile Illness to Fever of Unknown OriginThe Challenge Continues. (medscape.com)
  • Prolonged, undiagnosed fever is usually an atypical manifestation of a more common disease rather than a manifestation of an exotic illness. (snmjournals.org)
  • Fever is one of the most common manifestations of childhood illness. (biomedcentral.com)
  • Fever of unknown origin (FUO): which are the factors influencing the final diagnosis? (medscape.com)
  • Multiple myeloma rarely presents with a fever of unknown origin and diagnosis may be delayed. (metajournal.com)
  • 12. A rare presentation of endocarditis in adult-onset Still's disease in diagnosis of fever of unknown origin. (nih.gov)
  • In some cases the fever even precedes lymphadenopathy detectable by physical examination. (wikipedia.org)
  • Hepatic candidiasis may present with fever of unknown origin. (medscape.com)
  • Endemic mycoses such as histoplasmosis, blastomycosis, coccidiomycosis and paracoccidioidomycosis can cause a fever of unknown origin in immunocompromised as well as immunocompetent people. (wikipedia.org)
  • 15. [Fever of unknown origin and jaundice as the clinical presentation of myxoma of the right atrium]. (nih.gov)
  • Although the construction of the first building of The Rocky Mountain Labs was completed in 1928, RML evolved as a result of research on Rocky Mountain spotted fever that began around 1900, in the Bitterroot Valley of Western Montana. (nih.gov)
  • 4 Seventy-five percent of patients develop aching, malaise, and anorexia, and 9 percent develop low-grade fever. (aafp.org)
  • Hao R, Yuan L, Kan Y, Li C, Yang J. Diagnostic performance of 18F-FDG PET/CT in patients with fever of unknown origin: a meta-analysis. (medscape.com)
  • Sioka C, Assimakopoulos A, Fotopoulos A. The diagnostic role of (18)F fluorodeoxyglucose positron emission tomography in patients with fever of unknown origin. (medscape.com)
  • SIn patients receiving anti-neoplastic chemotherapy, the impact of influenza on the incidence of invasive pulmonary aspergillosis (IPA) remains unknown. (nih.gov)
  • For 21% of 115 patients with fever of unknown origin, serologic analysis showed that influenza was the major cause. (flutrackers.com)
  • If a thorough infectious disease work-up is negative, and associated with the lack of response to antibiotics and a lack of evidence of malignancy or a drug reaction, then directing treatment to SLE as the likely cause of the fever of unknown origin would be appropriate. (medscape.com)
  • At Infectious Disease Center, Hyderabad, we have special doctors who are trained to cure any sort of fever. (infectiousdiseasescenter.com)
  • Fever is not a disease - it's a symptom. (infectiousdiseasescenter.com)
  • No efficient vaccines exist against African swine fever virus (ASFV), which causes a serious disease in wild boars and domestic pigs that produces great industrial and ecological concerns worldwide. (mdpi.com)
  • 3. [Fever of unknown origin caused by the adult form of Still's disease]. (nih.gov)
  • 5. [Fever of unknown origin: Behcet's disease and adult still's disease]. (nih.gov)
  • 7. Adult Still's disease presenting as fever of undetermined origin in a patient with leukemoid reaction. (nih.gov)
  • 8. [Fever in collagen vascular disease]. (nih.gov)
  • 17. Adult-onset Still disease as the cause of fever of unknown origin. (nih.gov)
  • Early settlers of the valley were plagued with a deadly disease of unknown origin that seemed to be concentrated on the west side of the Bitterroot River. (nih.gov)
  • Serologic Analysis of Returned Travelers with Fever, Sweden (Emerg Infect Dis. (flutrackers.com)
  • With it, he explored the origins of Nipah and Hendra viruses in Malaysia and Australia. (nih.gov)
  • Infectious mononucleosis, most commonly caused by EBV, may present as a fever of unknown origin. (wikipedia.org)
  • A 38-year-old woman under allopurinol therapy for hyperuricemia was admitted in our department with fever and a diffuse cutaneous erythematous eruption. (nih.gov)
  • Children may also have a fever , headaches , tiredness, and a decreased appetite. (healthychildren.org)
  • These children have prolonged fever, which is called fever of unknown origin. (healthychildren.org)
  • 7 Prolonged fever of unknown origin in children has been described. (aafp.org)
  • Auto-inflammatory and auto-immune disorders account for approximately 5-32% of fevers of unknown origin. (wikipedia.org)
  • Coronavirus is a perfect storm pandemic virus - novel so unknown to the human immune system, easy to spread even when asymptomatic, sometimes hard to detect, unpredictable, and especially deadly in those with preexisting conditions. (preventionandhealing.com)
  • Fever of unknown origin: a retrospective study of 52 cases with evaluation of the diagnostic utility of FDG-PET/CT. (medscape.com)
  • Indeed, SLE commonly presents with polyarthralgias and polyarthritis in young women and may present as fever of unknown origin. (medscape.com)
  • I have a 35-year-old female patient with a 3-year history of polyarthritis who was admitted to the hospital with complaints of fever of a 3-week duration. (medscape.com)
  • Fever of unknown origin (FUO) refers to a condition in which the patient has an elevated temperature (fever) but, despite investigations by a physician, no explanation is found. (wikipedia.org)