How do fever patterns help in the identification of the etiology of fever of unknown origin (FUO)?

Updated: Mar 01, 2018
  • Author: Sandra G Gompf, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Fever with rigors or shaking chills is most suggestive of infection, as opposed to noninfectious inflammatory conditions.

In general, specific fever patterns do not correlate strongly with specific diseases. Notable exceptions include classic recurrent fevers, as follows:

  • Tertian fever in prolonged malaria (occurring every third day)
  • Undulant fever in brucellosis (evening fevers and sweats resolving by morning)
  • Tick-borne relapsing fever in borreliosis (week-long fevers with week-long remissions)
  • Pel-Ebstein fever in Hodgkin disease (week-long high fevers with week-long remissions)
  • Periodic fevers in cyclic neutropenia
  • Double quotidian fever (two fever spikes a day) in adult Still disease; also seen in malaria, typhoid, and other infections
  • Morning fevers in polyarteritis nodosa, tuberculosis, and typhoid

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