Edit concept Create issue ticket

Factitious Fever

Factitious fever (FF) is a false disease that can be secondary to psychiatric illness or malingering. It constitutes one of the differential diagnoses of fever of unknown origin (FUO). FF can be brought about by manipulation of medical findings and self-induced infection.


Presentation

Factitious fever (FF) is one of the possible presentations of chronic factitious illness. Factitious fever is further categorized as one of the possible causes of fever of unknown origin (FUO). FF can be caused by a range of psychiatric and non-existing illnesses, namely Munchausen syndrome, Munchausen syndrome by proxy, malingering, and various personality disorders. The patients with FF may present with atypical symptoms of a certain disease and may appear to be genuinely ill. They may deliberately falsify their history and tamper with physical findings to achieve this. This may be done for a number of reasons, such as in order to gain attention from health professionals. Individuals with FF may also change their hospital or caregivers frequently.

Of note, FF occurs more commonly among individuals with a medical background such as medical students, nurses, pharmacists, and laboratory technicians. One proposed explanation is that it is easier for them to gain access to medical supplies, as well as to garner attention from their colleagues.

There are a number of ways in which FF can be created and these include manipulation of thermometers to show a higher reading, infecting oneself using various contaminants, and taking drugs that raise body temperature [1] [2]. Self-induced infection may additionally result in recurrent episodes of skin and soft tissue infections such as cellulitis and abscesses or bacteremia that is poly-microbial. The isolated organisms could include Streptococcus viridans, Pseudomonas aeruginosa, and microbes found in fecal matter.

Other clues of FF are reported fever with no other systemic signs such as tachycardia or skin that is unusually warm to touch. FF may be a difficult diagnosis to make as FUO is in itself a challenge to clinicians [3]. FF is, however, one of the most prominent causes of FUO [4].

Sleep Apnea
  • Other highlights include expanded and updated discussions of sleep apnea, "minor" head trauma, cervical spine involvement in rheumatoid arthritis, transplantation-related problems, adverse effects of AIDS therapy, and more.[books.google.com]
Fever
  • Factitious fever (FF) is one of the possible presentations of chronic factitious illness. Factitious fever is further categorized as one of the possible causes of fever of unknown origin (FUO).[symptoma.com]
  • A retrospective study identified 2.2 per cent (11 of 506) of all patients whose fever on their charts was coded as fever of undetermined origin as having factitious fever.[ncbi.nlm.nih.gov]
  • FEVER October 1, 2012 by Dr Rajiv Desai FEVER: _ _ Prologue: “Humanity has but three great enemies: fever, famine, and war. Of these, by far the greatest, by far the most terrible, is fever.” – Sir William Osler.[drrajivdesaimd.com]
  • . factitious fever Fever produced artificially by a patient.[medical-dictionary.thefreedictionary.com]
  • . • To be able to have a plan to approach a patient with Fever when the basic clinical and laboratory tests did not reveal much as to the cause of fever Fever of unknown origin (FUO) :is a sustained, unexplained fever despite a comprehensive diagnostic[studyslide.com]
Rigor
  • . • 33 years old diabetic female present with fever of (39.5 C) for 3 days associated with rigor and loin pain. • 18 years old female presented with fever ranging (38.5 C -39.7 C) for 1 month duration, with previous history of multiple hospital admissions[studyslide.com]
  • Prostatitis - urinary symptoms, lower back pain, recent UTI or STI, catheterisation Malaria - Travel and exposure to insect bite (mosquito), recurring or intermittent fever, chills and rigors Rickettsial infections - travel and exposure to insect bite[fastbleep.com]
Laboratory Technician
  • Of note, FF occurs more commonly among individuals with a medical background such as medical students, nurses, pharmacists, and laboratory technicians.[symptoma.com]
  • Factitious Fever is more common amongst medical and paramedical staff e.g. nurses, pharmacists, bacteriologist, laboratory technicians and medical students, because of their familiarity with the hospital, easy access to thermometers and drugs and because[jpma.org.pk]
Rectal Bleeding
  • Seijffers, M.J. and Weiner, A. (1969) Massive rectal bleeding in a malingering patient. Dis. Colon Rectum, 12 : 347. 36.[jpma.org.pk]
Denial
  • However, as no clear structured methods are available to diagnose the FD and no clear guidelines are available to confront, precautionary methods need to be taken to avoid untoward outcomes like absconding and denial for follow-up.[ijpm.info]

Workup

Factitious fever should be approached with possible comorbidities and complications in mind. Possible complications of self-induced infection include bacterial endocarditis and septic pulmonary emboli. Psychiatric evaluation of the patient should also be carried out in the presence or absence of psychiatric symptoms, especially in chronic or repeated illness.

A thorough history and physical examination are instrumental in excluding possible causes of the fever [5] [6]. Routine laboratory tests such as complete blood count (CBC), inflammatory markers, metabolic panel, urinalysis, and blood and urine cultures should be carried out. In addition, various imaging modalities, such as chest X-rays and ultrasound, may also be carried out at the clinician's discretion. Computed tomography (CT) and magnetic resonance imaging (MRI) scans may be incorporated as the next step in the investigation.

Pseudomonas
  • The isolated organisms could include Streptococcus viridans, Pseudomonas aeruginosa, and microbes found in fecal matter. Other clues of FF are reported fever with no other systemic signs such as tachycardia or skin that is unusually warm to touch.[symptoma.com]
  • Cases of recurrent abscesses, cellulitis and self inflicted skin lesions due to self injection of tetanus toxoid, coliform bacilli, human and animal faecal organisms, tubercle bacilli pseudomonas aeruginosa and streptococcus viridans have been reported[jpma.org.pk]
Cryptococcus Antigen
  • antigen, histoplasmosis, coccidioidomycosis) • Protozoal and parasitic (toxoplasmosis, amoebiasis, schistosomiasis, leishmaniasis, trypanosomiasis) • PCR e.g for tuberculosis, herpes simplex virus (HSV), CMV, HIV, erythrovirus, dengue, Toxoplasma, Whipple's[studyslide.com]
Chlamydia Trachomatis
  • trachomatis infection; acquired syndromes associated with autoantibodies to cytokines;; management of multidrug resistant pathogens; probiotics, polymyxins, and the pathway to developing new antibiotics HIV including HIV and aging, antiretroviral therapy[books.google.com]

Treatment

  • This innovative one-page format provides the definition, differential diagnosis, workup and diagnosis, and treatment options for nearly 170 diseases and disorders.[books.google.de]
  • Furthermore, the psychiatric condition itself and iatrogenic complications of medication or other treatments can result in serious medical pathology.[books.google.com]
  • The primary treatment for Factitious Disorder is psychotherapy (a type of counseling). Treatment likely will focus on changing the thinking and behavior of the individual with the disorder (cognitive-behavioral therapy).[clevelandclinic.org]
  • Treatment Most children who undergo evaluation for FUO do not receive treatment until a clear-cut cause is found.[healthofchildren.com]
  • Treatment approach Medical and surgical treatments should be provided as needed to treat comorbidities and complications resulting from factitious disorder, malingering, and somatoform disorders.[clinicaladvisor.com]

Prognosis

  • Exceptions: empiric steroids for suspected GCA or empiric abx in neutropenic patients Prognosis Depends on age and etiology of FUO (worse with elderly and malignancy as etiology) Most without Dx after extensive evaluation have good prognosis with low[utswim.wordpress.com]
  • Stone, M.H. (1977) The borderline syndrome; evolution of the term genetic aspects, and prognosis. Am. J. Psychother., 31 :345. 42. Sullivan, M. and Trosow, A. (1949) Multiple subcutaneous abscesses produced by the hypodermic injection of feces.[jpma.org.pk]
  • Therapy is adjusted after a diagnosis is made. [3] Prognosis [ edit ] Since there is a wide range of conditions associated with FUO, prognosis depends on the particular cause. [1] If after 6 to 12 months no diagnosis is found, the chances diminish of[en.wikipedia.org]
  • These patients generally have a good prognosis, with resolution of fever in several months.[ime.acponline.org]
  • Prognosis- The patient's prognosis is dependent on the underlying disease process and by how soon a diagnosis is obtained. Outcomes are worse for neoplasms.[atsu.edu]

Etiology

  • Abstract The task of elucidating the etiology of fever of undertermined origin remains a major undertaking.[ncbi.nlm.nih.gov]
  • Molavi, A. and Weinstein, L. (1970) Persistent perplexing pyrexia, some comments on etiology and dagnosis. Med. Clin. North Am., 54 :379. 29.[jpma.org.pk]
  • Epidemiology Classic FUO etiologies fall into 5 major categories: Infection, Malignancy, Inflammatory, Miscellaneous, Unknown Distribution depends on decade, patient age, geography, and type of practice Etiology Infections Tuberculosis (extrapulmonary[utswim.wordpress.com]
  • Classification of Fever of Unknown Origin (FUO) Category of FUO Definition Common etiologies Classic Temperature 38.3 C (100.9 F) Duration of 3 weeks Evaluation of at least 3 outpatient visits or 3 days in hospital Infection, malignancy, collagen vascular[medicalcriteria.com]
  • FAILURE of a patient to awaken after general anesthesia may involve a complex array of etiologies that includes several life-threatening disease states. [1-3] The potential for patient harm requires the anesthesiologist to rapidly diagnose and, if needed[anesthesiology.pubs.asahq.org]

Epidemiology

  • Sweeping updates include new or revised chapters on: Hepatitis C and antivirals Fungal infection and newer antifungals Microbiome and infectious diseases as well as advances in diagnosis of infection; Clostridium difficile epidemiology; infection control[books.google.com]
  • Epidemiology Classic FUO etiologies fall into 5 major categories: Infection, Malignancy, Inflammatory, Miscellaneous, Unknown Distribution depends on decade, patient age, geography, and type of practice Etiology Infections Tuberculosis (extrapulmonary[utswim.wordpress.com]
  • RF, ANA, other inflammatory antibodies serology, according to local epidemiology HIV tuberculosis CMV EBV biopsy (liver, bone marrow) Diagnostic Imaging Imaging should initially include: chest X ray abdominal and pelvic ultrasound Other modalities could[sharinginhealth.ca]
  • […] has also been a case report on concurrent presence of FD and FD by proxy. [5] Another newer concept or problem in this field is "Munchausen by Internet," where a person may post false stories of his illness on internet forums to gain attention. [6] Epidemiology[ijpm.info]
  • I A. prospective multicenter study of 167 patients with FUO, using fixed epidemiologic entry criteria. The Netherlands FUO Study Group.[bmcresnotes.biomedcentral.com]
Sex distribution
Age distribution

Pathophysiology

  • […] labeled immunoglobulins, and 18-fluoro-deoxy-glucose. return to top Management If no causes are identified after work-up, a number of options are possible: watchful waiting inflammation tracer scintigraphy staged approach therapeutic trials return to top Pathophysiology[sharinginhealth.ca]

Prevention

  • The tenth issue in our growing online database, edited by James Newman, covers essential updates in the following topics: Long QT; Noninvasive ventilation; Fever of Unknown Origin; Post Bariatric Surgery; Hospital Fall Prevention; Mimics of Cellulitis[books.google.de]
  • Prevention Although FUO cannot actually be prevented because the sources are unknown, the immune system can be strengthened to help avoid infection from bacteria, viruses, and toxins.[healthofchildren.com]
  • Home Quick Reference AAP Textbook Textbook Pediatric Care Updates Well Child Resources Bright Futures Bright Futures Pocket Guide Interactive Periodicity Schedule Performing Preventive Services Bright Futures Questionnaires and Forms Policy Drug Lookup[pediatriccare.solutions.aap.org]
  • It is also important to drink enough liquids, to prevent dehydration. Familial Mediterranean fever (Medical Encyclopedia) Fever (Medical Encyclopedia) When your baby or infant has a fever (Medical Encyclopedia) [ Read More ][icdlist.com]
  • Better understanding and identification of these children is likely to help prevent the development of more chronic adult factitious disorders. factitious disorder Munchausen by proxy children adolescents factitious illness Received January 19, 1999.[pediatrics.aappublications.org]

References

Article

  1. Aduan RP, Fauci AS, Dale DC, Herzberg JH, Wolff SM. Factitious and self- induced infection; a report of 32 cases and review of literature. Ann Intern Med. 1979;90:230–242.
  2. Gershwin ME, Gude JK, Petralil J. Factitious Subcutaneous Emphysema. Ann Intern Med. 1971;75:585–587.
  3. Petersdorf RG. Fever of unknown origin. An old friend revisited. Arch Intern Med. 1992;152(1):21-22.
  4. Barbado FJ, Vázquez JJ, Peña JM, Arnalich F, Ortiz-Vázquez J. Pyrexia of unknown origin: changing spectrum of diseases in two consecutive series. Postgrad Med J. 1992;68(805):884-887.
  5. Hayakawa K, Ramasamy B, Chandrasekar PH. Fever of unknown origin: an evidence-based review. Am J Med Sci. 2012;344(4):307-316.
  6. Sipahi OR, Senol S, Arsu G, et al. Pooled analysis of 857 published adult fever of unknown origin cases in Turkey between 1990–2006. Med Sci Monit. 2007;13(7):CR318-322.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2018-06-22 07:38