Due to the advances in imaging and diagnostic procedures, differential diagnoses for fever of unknown origin can usually be narrowed down. However, when a patient does present with fever and no clear origin, it is truly a challenge to locate the inflammation or infection in a timely manner so that focused treatment can be employed.

Due to the advances in imaging and diagnostic procedures, differential diagnoses for fever of unknown origin can usually be narrowed down. However, when a patient does present with fever and no clear origin, it is truly a challenge to locate the inflammation or infection in a timely manner so that focused treatment can be employed.

Due to the advances in imaging and diagnostic procedures, differential diagnoses for fever of unknown origin can usually be narrowed down. However, when a patient does present with fever and no clear origin, it is truly a challenge to locate the inflammation or infection in a timely manner so that focused treatment can be employed.

DQ Question 

The clinical presentation of fever of unknown origin (FUO) in the geriatric population is a body temperature ≥ 101° F. The etiology of FUO in this population includes infections, connective tissue disorders, neoplasms, and miscellaneous. In geriatric patients with HIV infection, opportunistic infections like tuberculosis and infection by disseminated fungi, atypical mycobacteria, or cytomegalovirus should be suspected in FUO (David & Quinlan, 2022). The common connective tissue disorders associated with FUO include rheumatoid arthritis, systemic lupus erythematous, giant cell arteritis, polymyalgia rheumatic, vasculitis, and thyroiditis. The risk factors for UFO in older adults include Tuberculosis, Giant cell arteritis, Lymphomas, and Abscesses.

The common differential diagnoses for UFO in older adults include acute cholecystitis and gallbladder empyema. These can lead to an FUO diagnosis due to the lack of right upper quadrant pain or jaundice. Drug fever is a differential diagnosis since a history of drug allergy, skin rashes, or peripheral eosinophilia is mostly absent in cases of drug fever (David & Quinlan, 2022). Parasitic infections like malaria can be overlooked as a cause of fever. In addition, autoimmune diseases should be considered in elderly patients with FUO due to the potential for non-specific presentations. TB is usually a differential diagnosis for UFO.

The diagnostic workup for a patient with UFO includes blood cultures, complete blood count with differential, liver tests, Erythrocyte sedimentation rate, HIV antibody test, and Tuberculin skin test. The signs and symptoms guide imaging workups. Generally, areas of discomfort should be imaged, like a CT of the abdomen in older patients with abdominal pain or an MRI of the spine for those with back pain (Yadav et al., 2021). Treatment of FUO is usually focused on the underlying disorder. The choice of medications given to geriatric patients with UFO depends on the etiology. Antipyretics should be administered judiciously based on the duration of the fever (Yadav et al., 2021). UFO can be prevented by maintaining personal and environmental hygiene. 

References

David, A., & Quinlan, J. D. (2022). Fever of Unknown Origin in Adults. American family physician, 105(2), 137–143.

Yadav, B. K., Pannu, A. K., Kumar, R., Rohilla, M., & Kumari, S. (2021). Fever of Unknown Origin in Older Adults: A Prospective Observational Study from North India. The Journal of the Association of Physicians of India, 69(10), 11–12.

ORDER A PLAGIARISM-FREE PAPER HERE

please answer DQ fully for full credit

Due to the advances in imaging and diagnostic procedures, differential diagnoses for fever of unknown origin can usually be narrowed down. However, when a patient does present with fever and no clear origin, it is truly a challenge to locate the inflammation or infection in a timely manner so that focused treatment can be employed.

You are the AGACNP hospitalist provider tasked with admitting the following patient to the hospital. The patient is:

1. A 40-year-old, Hispanic, developmentally delayed, female from a local long-term care center with early dementia, DM-2 (insulin dependent), neurogenic bladder, hypertension, and systolic dysfunction (EF 30%) due to ischemic cardiomyopathy.
2. Brought by emergency medical transport to the emergency department with altered mental status and the following vital signs: oral temp is 101.5, HR 72, RR=28, and oxygen saturation on room air is 88%.
3. Currently on prednisone 20 mg daily for temporal arteritis, and Coreg 12.5 mg BID, Namenda 10 mg daily, Lasix 40 mg daily, Levemir 20 units SQ BID, metformin 500 mg BID, and sliding scale insulin.

Explain the presentation, etiology, risk factors, common differential diagnosis, typical diagnostic work-up, treatment plan (based on current clinical guidelines and evidence-based therapy), preventative measures (if any), and additional information that would be important to the geriatric population with regard to fever of unknown origin. Support your summary and recommendations plan with a minimum of two APRN-approved scholarly resources.