Fever of unknown origin in special groups.

Fever of undetermined origin (FUO) is a challenging entity with a striking presence in hospitals around the world. It is defined as temperature ≥ 37.8 ° C on several occasions, lasting ≥ three weeks, in the absence of diagnosis after three days of hospital investigation or 3 outpatient visits. The main etiologies are infectious, neoplastic, and non-infectious inflammatory diseases. The diagnosis is based on the detailed clinical history and physical examination of these patients, in order to direct the specific complementary tests to be performed in each case. The initial diagnostic approach of the FUO patient should include non-specific complementary exams. Empirical therapy is not recommended (with few exceptions) in patients with prolonged fever, as it may disguise and delay the diagnosis and conduct to treat the specific etiology. The prognosis encompasses mortality of 12-35%, varying according to the baseline etiology.

Fever of unknown origin in special groups

SUMMARY Fever of undetermined origin (FUO) is a challenging entity with a striking presence in hospitals around the world. It is defined as temperature ≥ 37.8 ° C on several occasions, lasting ≥ three weeks, in the absence of diagnosis after three days of hospital investigation or 3 outpatient visits. The main etiologies are infectious, neoplastic, and non-infectious inflammatory diseases. The diagnosis is based on the detailed clinical history and physical examination of these patients, in order to direct the specific complementary tests to be performed in each case. The initial diagnostic approach of the FUO patient should include non-specific complementary exams. Empirical therapy is not recommended (with few exceptions) in patients with prolonged fever, as it may disguise and delay the diagnosis and conduct to treat the specific etiology. The prognosis encompasses mortality of 12-35%, varying according to the baseline etiology.

RESUMO Febre de origem indeterminada (FOI) é uma entidade desafiadora com presença marcante nos hospitais de todo o mundo. É definida como temperatura ≥37,8 ° C em várias ocasiões, com duração ≥3 semanas, na ausência de diagnóstico após três dias de investigação hospitalar ou três consultas ambulatoriais. As principais etiologias são de ordem infecciosa, neoplásica e doenças inflamatórias não infecciosas. O diagnóstico é baseado na história clínica e no exame físico minuciosos desses pacientes, com a finalidade de direcionar os exames complementares específicos a serem realizados em cada caso. A abordagem diagnóstica inicial do paciente com FOI deve incluir exames complementares inespecíficos. A terapia empírica não é recomendada (com poucas exceções) em pacientes com febre prolongada, uma vez que ela pode camuflar e retardar o diagnóstico e a conduta para tratar a etiologia específica. O prognóstico engloba uma mortalidade de 12-35%, variando de acordo com a etiologia de base.

Fever of unknown origin - a literature review.

Fever of undetermined origin (FUO) is a challenging entity with a striking presence in hospitals around the world and can be associated with a myriad of differential diagnoses. It is defined as axillary temperature ≥ 37.8 ° C on several occasions, lasting ≥ three weeks, in the absence of diagnosis after three days of hospital investigation or three outpatient visits. The main etiologies are: infectious, neoplastic, and rheumatic. The diagnosis is based on the detailed clinical history and physical examination of these patients, in order to direct the specific complementary tests to be performed in each case. Empirical therapy is not recommended (with few exceptions) in patients with prolonged fever, as it may disguise and delay the diagnosis and conduct to treat the specific etiology. The prognosis encompasses mortality of 12% - 35%, varying according to the underlying etiology. In this sense, the objective of this study is to review the main topics about fever of undetermined origin, bringing historical and scientific aspects, national and international.

Fever of unknown origin - a literature review

SUMMARY Fever of undetermined origin (FUO) is a challenging entity with a striking presence in hospitals around the world and can be associated with a myriad of differential diagnoses. It is defined as axillary temperature ≥ 37.8 ° C on several occasions, lasting ≥ three weeks, in the absence of diagnosis after three days of hospital investigation or three outpatient visits. The main etiologies are: infectious, neoplastic, and rheumatic. The diagnosis is based on the detailed clinical history and physical examination of these patients, in order to direct the specific complementary tests to be performed in each case. Empirical therapy is not recommended (with few exceptions) in patients with prolonged fever, as it may disguise and delay the diagnosis and conduct to treat the specific etiology. The prognosis encompasses mortality of 12% - 35%, varying according to the underlying etiology. In this sense, the objective of this study is to review the main topics about fever of undetermined origin, bringing historical and scientific aspects, national and international.

RESUMO Febre de origem indeterminada (FOI) é uma entidade desafiadora com presença marcante nos hospitais de todo o mundo, à qual uma miríade de diagnósticos diferenciais podem estar associados. É definida como temperatura axilar ≥37,8 0 C em várias ocasiões, com duração ≥ três semanas, na ausência de diagnóstico após três dias de investigação hospitalar ou três consultas ambulatoriais. As principais etiologias são de ordem infecciosa, neoplásica e reumatológica. O diagnóstico é baseado na história clínica e no exame físico minuciosos desses pacientes, com a finalidade de direcionar os exames complementares específicos a serem realizados em cada caso. A terapia empírica não é recomendada (com poucas exceções) em pacientes com febre prolongada, uma vez que ela pode camuflar e retardar o diagnóstico e a conduta para tratar a etiologia específica. O prognóstico engloba uma mortalidade de 12-35%, variando de acordo com a etiologia de base. O objetivo deste estudo é revisar os principais tópicos acerca da febre de origem indeterminada, trazendo aspectos históricos e científicos, nacionais e internacionais.

Granulomatose com poliangiite: atualização do diagnóstico ao tratamento / Granulomatosis with polyangiitis: updates from diagnosis to treatment

Introdução: Granulomatose com poliangiite (GPA) é uma vasculite granulomatosa necrosante pauci-imune que afeta predominantemente pequenos vasos. É uma doença rara, de etiologia multifatorial, e constitui importante diagnóstico diferencial das síndromes pulmão-rim. Objetivo: atualizar os principais tópicos acerca da granulomatose com poliangiite, além de trazer perspectivas futuras e avanços no manejo clínico dessa vasculite. Metodologia: revisão de literatura realizada em 2018 a partir das publicações dos últimos 5 anos nas base de dados do PubMed Central® e da SciELO®. Resultados: 29 referências bibliográficas selecionadas, das quais: 16 revisões de leteratura; 2 revisões sistemáticas; 1 estudo transversal; 2 estudos caso-controle; 6 coortes; 2 consensos atualizados (1 brasileiro de 2017 e 1 internacional de 2017). Conclusão: a granulomatose com poliangiite é uma entidade de elevada morbimortalidade, e teve seu algoritmo de tratamento recentemente atualizado, conforme abordado nesta revisão. Novos estudos ainda em estão em andamento para avaliar a eficácia e segurança de novas abordagens terapêuticas.

Introduction: Granulomatosis with polyangiitis (GPA) is a pauci-immune necrotizing granulomatous vasculitis that affects predominantly small vessels. It is a rare disease with a multifactorial etiology and an important differential diagnosis of Pulmonary-renal syndromes. Objective: to update the main topics about granulomatosis with polyangiitis, in addition to bringing future perspectives and advances in the clinical management of this vasculitis. Methodology: literature review conducted in 2018 from the publications of the last 5 years in PubMed Central® and SciELO® databases. Results: 29 selected bibliographical references, of which: 16 literature reviews; 2 systematic reviews; 1 cross-sectional study; 2 case-control studies; 6 cohorts; 2 updated consensuses (1 Brazilian, 2017 and 1 international, 2017). Conclusion: granulomatosis with polyangiitis is an entity with high morbidity and mortality, and its treatment algorithm has recently been updated, as discussed in this review. Further studies are underway to evaluate the efficacy and safety of novel therapeutic approaches.