Laboratory Data

1. Cultures. Be certain that key cultures (usually blood, urine, throat, and occasionally stool or local lesions) have been taken for analysis.

2. Screening tests. Several studies have documented that inflammatory markers are strong evidence of more serious causes of prolonged fever: increased ESR, elevated C-reactive protein, and low albumin with reversal of the albumin-globulin ratio. These tend to be sensitive but not specific for serious disorders. Patients without markers of chronic inflammation may warrant observation rather than intense investigation. Although a specific diagnosis is usually not made, CBC with platelets and comprehensive metabolic profile should be ordered for most patients, especially to screen renal and hepatic function.

3. Titers. Several disorders are best diagnosed with antibody titers (eg, Lyme disease, Epstein-Barr infection, tularemia, cat-scratch disease). If these are likely diagnoses, titers should be sent rapidly because paired titers may be necessary.

4. Bone marrow exam. Should not be routine, except perhaps in immunocompromised patients. If there are reductions in at least two cell lines from a CBC, marrow exam may be useful to look for malignancy.

C. Radiographic and Other Studies. Radiology consultation is extremely useful when making decisions about the best imaging test.

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