Pyrexia of unknown origin
Emergency referrals
Consider urgent referral for patients with the following:
- Altered conscious level
- Suspicion of meningitis
- Suspicion of endocarditis
- A PUO, (see criteria below) especially if the patient is unwell, would be grounds for urgent referral through Emergency. It is likely that most patients fitting this description would be admitted through Emergency for investigation. Do not delay urgent referral if the patient is unwell or deteriorating. If in doubt contact the ID registrar/specialist for advice.
Pyrexia of unknown origin (PUO) is defined as:
- Temperature greater than 38.3℃ on several occasions
- Accompanied by more than 3 weeks of illness
- Failure to reach a diagnosis after 1 week of investigation
Most patients with PUO will be referred urgently through Emergency. If in doubt how to refer this condition contact the Infectious Diseases registrar at your local hospital or an Infectious Diseases physician.
Other important information for referring practitioners
Medical management
Most are caused by uncommon presentations of common diseases e.g. tuberculosis, endocarditis, gall bladder disease or HIV.
In adults
- Infections and cancer (25-40%)
- Autoimmune disorders (10-20%)
Specific causes
- Infection
- Bacterial (hepatobiliary, occult abscess, osteomyelitis, brucellosis, treponemal disease, gonococcal disease)
- Viral (CMV, EBV, HIV)
- Fungal
- Parasitic (toxoplasma, trypanosomiasis, leishmania, amoeba
- Rickettsial infection (Coxiella burnetii)
- Chlamydial (esp psittacosis)
- Cancer
- Lymphomas, renal cell carcinoma, malignant histiocytosis
- Autoimmune disease (Juvenile RA, polyarteritis nodosa, MCTD
- Drugs ( beta lactam antibiotics, isoniazid)
- Other (granulomatous disease, vasculitides, PE, familial Mediterranean fever, hyperthyroidism)
If the cause of a fever is not immediately apparent, take a full history. Consider:
- Foreign travel, contact with foreign visitors,
- Occupational exposure
- Look for evidence of immunosuppression
- Recent opportunistic infections
- High risk behaviour ( IV drug use)
Examine closely for:
- Lymphadenopathy
- Check ENT
- Examine skin for rashes
- Check nails for splinter haemorrhages
- Auscultate for murmurs
- Examine the chest
- Examine abdomen for masses, tenderness
- Check testes and prostate in men
- Perform pelvic examination in women
Perform first round investigations using broad screening tools (FBC, E/LFT, ESR, CRP, 2 sets of blood cultures from separate sites & CXR). Only use specific investigations when guided by suspicion from history or examination.
Refer urgently if patients condition is progressive and further investigation may delay management.
Referral requirements
A referral may be rejected without the following information.
Send referral
Hotline: 1300 364 938
Fax: 1300 364 952
Electronic: eReferral system
Mail: Metro North Central Patient Intake
Aspley Community Centre
776 Zillmere Road
ASPLEY QLD 4034
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