Comment on Pyrexia of unknown origin

Editor – The CME section on infectious diseases contained a most interesting article by Fernandez and Beeching on the important subject of pyrexia of unknown origin.¹ However, I feel that there was one important area that they failed to address, namely how temperature should actually be measured. This is especially important in identifying cases of factitious fever, a topic which they listed but did not actually address, but which may be an important feature of Munchausen's syndrome (and Munchausen's syndrome by proxy). I recall being taught as a student of the value of measuring the temperature of freshly passed urine as being a method that circumvented patient's attempts at artefactually tampering with temperature measurement, and which could also be used in restless or uncooperative individuals; but perhaps the authors might be invited to tell us how things should be done in the modern era.