Good practice points in the management of pyrexia of unknown origin
| There are many pitfalls in the investigation and management of pyrexia of unknown origin (PUO). The following good-practice points are recommended. |
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| Ensure a thorough history, examination and baseline investigation panel have been done. |
| Return to the patient's history and examination at regular intervals. |
| Consider non-infectious causes of a fever early on in the patient's journey. |
| All patients with PUO should have an HIV test. |
| Exclude malaria in patients with a history of relevant travel within the last 2 years. |
| A positive tuberculin or interferon gamma release assay is not diagnostic for TB: microbiological confirmation through bacterial culture or molecular testing is required. |
| Do not give empirical antimicrobial or steroid trials. |
| Be cautious with the interpretation of some serological tests as some perform poorly with high false positive and false negative rates. |
| Do not perform serological testing if there is no history of exposure to the pathogen you are testing for. |
| Perform PET-CT testing early in the patient's diagnostic journey when there are no localising clues in the history or examination. |
| Ensure that the patient is aware of the strong possibility of no diagnosis being made. |