الفهرس 
Introduction
Definition of PUOOnly 14 pages are availabe for public view
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Abstract
Pyrexia of unknown origin (PUO) is one of the most challenging diagnostic dilemmas in the field of infectious diseases and tropical medicine.
Most febrile conditions are readily diagnosed on the basis of presenting symptoms. Occasionally, simple testing such as a complete blood count or urine Culture is required to make a definitive diagnosis.
In this study 90 patients admitted in Fever Unit of Tropical Medicine and Gastroenterology department in Assiut University Hospitals to evaluate the relative frequency of classical PUO among patients admittedfrom January 2014till July 2017and to determine the different patterns of fever amongthe studied patients in this period.
Patients were diagnosed as classical PUO in their medical reports who fulfill inclusion and exclusion criteria of classical PUO.
The original criteria invoked by Petersdorf and Beeson were:
i) Fever higher than 38.3º C (101 F) on several occasions, usually interpreted as at least three,
ii) Illness of more than 3 weeks duration
iii) No diagnosis made after 1 week of inpatient investigation.
The present study included 90 patients with pyrexia of unknown origin in which the patientmean age is 45years±15.76.
Frequency ofclassical PUO cases:
Among patients admitted to fever unit during the study period from January 2014 to July 2017 is 90 /2431 (3.7%).
Pattern offeverin our study:
Out of 90 patients with criteria of classical PUO included in the current study, 58 (64.4%) patients presented with relapsing fever, 29 (32.3%) patients presented with continous fever and3 (3.3%) patients presented with remittent fever.
Relapsing fever was observed in 58 (64.4%) Patients, 10 (11.1%) out of them were diagnosed to have Brucellosis, 11 (12%) out of them were diagnosed to have lymphoma, 6 (6.6%) out of them were diagnosed to have connective tissue disease, 4 (4.4%) out of them were diagnosed to have leukemia, and one (1.1%) patient had familial mediterenian fever, interestingly 15 (16.6%) out of58 (64.4%) patients diagnosis couldnot be reached.
Patients presented with continuous fever were 29 (32.3%) patients, 14 (15.6%) out of them were diagnosed to have salmonellosis, 7 (7.8%) of them had pyelonephritis, 7 (7.8%) out of them were undiagnosed and one (1.1%) patienthadcytomegalovirus infection.
Three patients (3.3%) had pyogenic liver abscess presented with remittent fever.
Most of the cases of PUO (41.11%)were in the middle age(21 to 40years),Females were commonly affected than males (58.89% Vs 41.11%).
Most of the studied patients presented with relapsing fever (58/90, 64.4%) where as continuous fever was found in (29/90, 32.3%) of patients with PUO. In addition remittent fever represented in 3 patients (3.3%).
On systemic examination,all patients included in the current study had normal neurological,chest and heart examination,free abdominal examination presented in 77 subjects (85.6%)while7(7.7%), 4 (4.5%)and 2 (2.2%) subjects had hepatosplenomegaly,hepatomegaly and splenomegaly respectively.
In our study, preliminary investigation like haemogram with peripheral smear, urine analysis were normal in most of the patients.
On haemogram,45 patients (50 %) had anaemia,28 patients (31.12%) had leukocytosis, and 12 patients (13.33 %) had leucopenia.
Abnormal urine analysis was found in 14 patients with PUO; where 9 patients had albuminuria and 5 of them hadpyuria.
Among60/90 (66.5%) ofpatients with PUO who had positive abdominal ultrasonographic findings, 22/90 (24.4%) had hepato-splenomegally where 9 of them had abdominal ultrasonography.
In the current study of 90 patients of classical PUO, diagnosis could be made in 68 patients(75.6%) and despite the adequate work up, diagnosis could not be made in the other 22 patients (24.4%).
Infectious diseases were found to be the leading cause of the classical PUO; 46 of the 90 (51.1%) patients. Among the infectious causes, salmonellosis was the most common cause, (14 subjects (15.6%) ofPUO).
Whereasthe other infectious causes; 10 subjects (11.1%)had brucellosis, 9 subjects (10%)had TB peritonitis, 7 subjects (7.7%) had pyelonephritis, 3 subjects (3.3%) had pyogenic liver abscess, 2 subjects (2.2%)had Tuberculous lymphadenitis and one subject (1.1%) had cytomegalovirus infection.
15 patients (16.6%) diagnosed to have malignant disease8 subjects (8.9%) had Hodgkin lymphoma, 3subjects (3.3%) had Non Hodgkin lymphoma, 3 subjects (3.3%) had acute myeloid leukemiaand onesubject (1.1%) hadchronic myeloid leukemia.
Moreover FMF was found in 1.1% of the studied patients presented with PUO.
In Conclusion :
• One of the problems most frequently encountered in medical practice is the diagnosis of prolonged fever with or without local signs of disease.
• PUO represent (3.7%) ofpatients admitted to the fever unit of Tropical Medicineand Gastroenterology department.
• PUO is still a problematic condition with multiple causative agents and abroad investigations even with the new investigatory techniques.
• The most common patternof fever is relapsing fever, followed by continuous and atlastremittentfever.
• Pyrexia of unknown origin continues to be aclinical condition, anddefies technical advances in diagnostic modalities and the expertise of the clinical physician that perplexes both the physician and the patient.
• It is important to realize PUO may represent uncommon manifestation of common disease. Bacterial infection is the prevelantcause; where salmonellosis, brucellosis and tuberculosis arethe frequentpathogens associated diseases.
• Non infectious causes like collagen, vascular disease and neoplasm are becoming important differential diagnosis
• Causative diseases underlying PUO vary by region and time period, and evaluation of these causes over awide area usingrecent data is important