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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].

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]
  • . 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]
  • Factitious Fever Pages with reference to book, From 189 To 191 Factitious fever is one of the causes of fever of unknown origin.[jpma.org.pk]
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]
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]
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]
Self-Mutilation
  • Also found in: Dictionary , Thesaurus , Legal , Encyclopedia . factitious fever A fever of unknown origin described in either young female health professionals, which occurs after a legitimate disease, or in older neurotic female who are prone to self-mutilation[medical-dictionary.thefreedictionary.com]
  • [Case of self mutilation of urethra in a Munchausen's syndrome patient]. Hinyokika Kiyo. Nov 2007;53(11):829-831. Schmidt F, Strutz F, Quellhorst E, Muller GA. Nephrectomy and solitary kidney biopsy in a patient with Munchausen's syndrome.[nzma.org.nz]
Self Mutilation
  • Also found in: Dictionary , Thesaurus , Legal , Encyclopedia . factitious fever A fever of unknown origin described in either young female health professionals, which occurs after a legitimate disease, or in older neurotic female who are prone to self-mutilation[medical-dictionary.thefreedictionary.com]
  • [Case of self mutilation of urethra in a Munchausen's syndrome patient]. Hinyokika Kiyo. Nov 2007;53(11):829-831. Schmidt F, Strutz F, Quellhorst E, Muller GA. Nephrectomy and solitary kidney biopsy in a patient with Munchausen's syndrome.[nzma.org.nz]
Psychiatric Symptoms
  • Using extensive notes and tables throughout, these distinguished contributors have created far more than just another compendium of medical illnesses that can present with psychiatric symptoms.[books.google.com]
  • Psychiatric evaluation of the patient should also be carried out in the presence or absence of psychiatric symptoms, especially in chronic or repeated illness.[symptoma.com]
  • The most notable exceptions are cyclic neutropenia, malaria, and Hodgkin disease. 6,10 Family history, ethnicity, medications, habits, travel history, social environment, sexual history, and psychiatric symptoms can yield valuable information.[nursingcenter.com]
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.

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]
Chlamydia
  • […] 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 in the ICU setting; Chlamydia[books.google.com]
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]

Treatment

  • Prompt detection not only spares patients prolonged hospitalization and unwarranted treatment and procedures, but more important, it allows appropriate psychiatric care to be offered. 2,3 Since early detection can be viewed as the clinician's primary[jamanetwork.com]
  • Furthermore, the psychiatric condition itself and iatrogenic complications of medication or other treatments can result in serious medical pathology.[books.google.com]
  • No clearly effective treatments Treatment of factitious disorder imposed on self is usually challenging, and there are no clearly effective treatments.[msdmanuals.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]
  • The non-punitive confrontation, which reformulates the disorder as a request for help, promotes patient adherence to psychiatric treatment. 8 Treatment of Munchausen's syndrome should focus on the underlying motivations.[elsevier.es]

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]
  • What is the prognosis (outlook) for people with Factitious Disorder? Some people with Factitious Disorder suffer one or two brief episodes of symptoms.[clevelandclinic.org]

Etiology

  • Five such patients are described, with special attention to family interrelationships as etiologically relevant to the diagnosis.[journals.sagepub.com]
  • 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]
  • Of these, 116 (79%) patients were finally diagnosed with one of the following etiologies: infectious disease (37%), connective tissue disorders (16%), malignancy (14%), and miscellaneous disorders (12%) including Kikuchi's disease, factitious fever, drug-related[ekjm.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]
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]
  • 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]
  • ‘a largely factitious national identity’ ‘First, by so doing, he could secure a factitious glory at home; this would prevent or, at least, postpone the rise of a new opposition.’[en.oxforddictionaries.com]

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.

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Last updated: 2019-07-11 21:41