Prevention and Care of

Pyrexia of Unknown Origin

By
N.Rajendra Babu
S.P.M
 Objectives :

• Introduction

• Public health importance

• Prevention and Care

 Introduction

• Definition :Fever of unknown origin (FUO), pyrexia of unknown,

origin (PUO) ,Refers to a condition in which the patient has an
elevated temperature but despite investigations by a physician no
explanation has been found.

o Measurement: Temperature >38 .0 degree c (>100.4 degree f

Rectal temparature, Oral – 0.6 c less, Auxillary is 1.1 c less)

o Can be define a barrier stage between infection and immune

mechanism of the host
• Criteria :In 1961 Petersdorf and Beeson suggested the following
criteria:

o Fever higher than 38.3 °C (101 °F) on several occasions,

o Persisting without diagnosis for at least 3 weeks,
o At least 1 week’s investigation in hospital.
or
According to new definition for outpatient setting:
o 3 outpatient visits or
o 3 days in the hospital without elucidation of a cause
o 1 week of “intelligent and invasive” ambulatory
investigation.
• Classification:

a) According to infection

o Classic Infections (e.g. abscesses, endocarditis,tuberculosis, and

complicated urinary tract infections) Neoplasms (e.g.
lymphomas, leukaemias),
o Nosocomial
o Connective tissue diseases (e.g. temporal arteritis and
polymyalgia rheumatica, Still’s disease,systemic lupus
erythematosus, and rheumatoid arthritis),
o Immunodeficient conditions and HIV related
o Miscellaneous disorders (e.g. alcoholic hepatitis, granulomatous
conditions),
o Undiagnosed conditions.
 b) According to duration:
o Acute onset:<7 days.
o Prolanged :>7 days.
c) According to age group:
o Pediatric
o Adult
 Public health Importance

• Etiology and natural history of the disease (source-transmission

–host relation )
• Conditions: PUO should diferentiate with tropical diseases like
Malaria, Dengue, Influenza like infections ,SARS, Ebola and other
viral infections
• Epidemicity (out break) or endemocity (geographical
distribution)
• Vulnerability (eg: targeted population or community)
• Immunity ( eg: ring immunization)
• Pathogenicity
• Prevention and care
• Etiology and natural history of the disease (source-transmission
–host relation )

o Most of the PUO cases are unknown etiology or natural history of

the disease.

o Source-Transmission –Host (STH) ,depend up on their specificity.

o Need to differentiate between infections.

o Early understanding can help to prevent further spread of the

disease.
• Conditions: Tropical diseases like Malaria, Dengue, Influenza like
infections ,SARS, Ebola and other viral infections:

o Most of the PUO conditions, are identical features, need to

differentiate with each other.

o Early diagnosis ,with public health laboratory surveillance is

crucial .

o Identification of susceptible and other affected communities are

important
• Epidemecity (out break) or endemecity

o Type of condition.

o Geographical distribution (GIS-Geographical Information System) .

o Is it public health emergency, (egg : influenza , dengue etc).

o Response : rapid response or routine response teams allocation.

• Vulnerability:

o Targeted population or community (pediatric population

,pregnant women's, geriatric population etc..).

o Involvement of race ,ethnicity ,specific species ,etc..

o Role of socio—religious and cultural factors.

• Immunity :

o Host defence (active or passive).

o Herd structure.

o Availability of the Immunizing agents(live or killed ) and their

effectiveness.
• Pathogenicity:

o Successful parasitism.

o Incubation period and Period of infectivity.

o Latent period and Generation time.

o Period of communicability.

o Secondary attack rate (SAR).

 Prevention and Care

• Pre epidemic era:

o Primary prevention:

a) Health education.

b) Target intervention of high risk or vulnerable population (specific

protection egg: immunization, chemoprophylaxis etc.)
• Epidemic era:

o Secondary prevention :

a) Early identification and diagnosis ( egg: arboviral infections,

malaria like fevers, influenza like fevers etc.

b) Prompt care and treatment.

c) Epidemiological surveillance.

d) Continuous monitoring.
• Post epidemic era:

a) Epidemiological surveillance and monitoring .

b) Prevention of future out breaks.

c) Research and further studies (egg: disease occurrence and

molecular pathogenesis, vaccination and other preventable
measures).

d) Collaboration and convergence with in the nations and

internations.
Thank you.