Fever of Unknown Origin History

Aka: Fever of Unknown Origin History

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II. History: Fever

  1. See Fever Pattern
  2. Thermometer used and by what route?
  3. What was peak Temperature?
  4. Did fever occur at predictable time of day?
  5. Did fever occur daily, or intervening afebrile days?
  6. What was response to antipyretics?

III. History: Systemic Symptoms

  1. Weight loss
  2. Decreased appetite
  3. Decreased activity
  4. Onset of symptoms (Do symptoms precede fever?)
  5. Rash
  6. Arthralgia

IV. History: Localized Symptoms

  1. Headache
  2. Personality change
  3. Cough
  4. Abdominal Pain
  5. Urinary Symptoms
  6. Bone pain
    1. Local pain in Osteomyelitis
    2. Multifocal pain in malignancy

V. History: Travel history and Exposures

  1. Travel outside United States (Vaccines or prophylaxis?)
    1. Tuberculosis
    2. Malaria
    3. Hepatitis
    4. Salmonellosis
    5. Brucellosis,
    6. Leptospirosis
    7. Q Fever
    8. Various Mycoses and Parasites
  2. Camping or travel in wooded areas (Tick Bites)
    1. Rocky Mountain Spotted Fever
    2. Lyme Disease
    3. Relapsing Fevers
  3. Contagious Contacts
    1. Tuberculosis
    2. Salmonellosis
    3. Cytomegalovirus
    4. Epstein-Barr Virus
  4. Daycare
    1. Cytomegalovirus
    2. Tuberculosis
    3. Hepatitis A
    4. Salmonellosis
  5. Fresh water exposure
    1. Leptospirosis
  6. Animal Exposure
    1. Dogs or Rodents or their urine (Leptospirosis)
    2. Pet turtles (Salmonella)
    3. Rats (Rat bite fever)
    4. Cats (Toxoplasmosis)
    5. Parrots or psittacine birds (Psittacosis)
    6. Pigeons (Coccidioides)
    7. Sheep or other farm animals (Brucellosis)
  7. Recent hospitalization
    1. Nosocomial Infection

VI. History: Dietary

  1. See Foodborne Illness
  2. Recent potential infectious sources
    1. Unpasteurized dairy products
    2. Raw Meat
    3. Raw Fish
    4. Wild rabbit
  3. Pica suggests possible underlying infections
    1. Visceral Larva Migrans
    2. Toxoplasmosis
    3. Brucella
    4. Salmonellosis

VII. History: Medical, Family, Social

  1. Family History
    1. Familial Mediterranean Fever
  2. Medical conditions
    1. Abdominal conditions
      1. Alcoholic Hepatitis
      2. Cirrhosis (Spontaneous Bacterial Peritonitis)
    2. Transfusion history
      1. Hepatitis B
      2. Hepatitis C
      3. HIV Infection
    3. Cancer
      1. Metastases
  3. Surgical history
    1. Prosthetic device or arthroplasty
      1. Osteomyelitis
  4. Social history
    1. Intravenous Drug Abuse
      1. Abscess
      2. Endocarditis
      3. Osteomyelitis
    2. Sexually Transmitted Infection
      1. Acute HIV Infection
      2. Gonorrhea

VIII. References

  1. David (2022) Am Fam Physician 105(2): 137-43 [PubMed]
  2. Hersch (2014) Am Fam Physician 90(2): 91-6 [PubMed]

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