Diagnostic workup for fever of unknown origin: a multicenter collaborative retrospective study
Toshio Naito,Masafumi Mizooka,Fujiko Mitsumoto,Kenji Kanazawa,Keito Torikai,Shiro Ohno,Hiroyuki Morita,Akira Ukimura,Nobuhiko Mishima,Fumio Otsuka,Yoshio Ohyama,Noriko Nara,Kazunari Murakami,Kouichi Mashiba,Kenichiro Akazawa,Koji Yamamoto,Shoichi Senda,Masashi Yamanouchi,Susumu Tazuma,Jun Hayashi +19 more
TLDR
O due to deep-seated abscess or solid tumour is decreasing markedly with the widespread use of CT, and diseases that should be considered in the differential diagnosis of FUO are identified.Abstract:
Objective Fever of unknown origin (FUO) can be caused by many diseases, and varies depending on region and time period. Research on FUO in Japan has been limited to single medical institution or region, and no nationwide study has been conducted. We identified diseases that should be considered and useful diagnostic testing in patients with FUO. Design A nationwide retrospective study. Setting 17 hospitals affiliated with the Japanese Society of Hospital General Medicine. Participants This study included patients ≥18 years diagnosed with ‘classical fever of unknown origin’ (axillary temperature ≥38°C at least twice over a ≥3-week period without elucidation of a cause at three outpatient visits or during 3 days of hospitalisation) between January and December 2011. Results A total of 121 patients with FUO were enrolled. The median age was 59 years (range 19–94 years). Causative diseases were infectious disease in 28 patients (23.1%), non-infectious inflammatory disease in 37 (30.6%), malignancy in 13 (10.7%), other in 15 (12.4%) and unknown in 28 (23.1%). The median interval from fever onset to evaluation at each hospital was 28 days. The longest time required for diagnosis involved a case of familial Mediterranean fever. Tests performed included blood cultures in 86.8%, serum procalcitonin in 43.8% and positron emission tomography in 29.8% of patients. Conclusions With the widespread use of CT, FUO due to deep-seated abscess or solid tumour is decreasing markedly. Owing to the influence of the ageing population, polymyalgia rheumatica was the most frequent cause (9 patients). Four patients had FUO associated with HIV/AIDS, an important cause of FUO in Japan. In a relatively small number of cases, cause remained unclear. This may have been due to bias inherent in a retrospective study. This study identified diseases that should be considered in the differential diagnosis of FUO.read more
Citations
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Fever of unknown origin
TL;DR: The definition, diagnostic workup, causes, treatment and treatment of FUO are described and Corticosteroids should be avoided in the absence of a diagnosis, especially at an early stage.
Journal ArticleDOI
Fever of unknown origin (FUO): which are the factors influencing the final diagnosis? A 2005–2015 systematic review
Francesco Maria Fusco,Raffaella Pisapia,S. Nardiello,Stefano Domenico Cicala,Giovanni Battista Gaeta,Giuseppina Brancaccio +5 more
TL;DR: Despite advances in diagnostics, FUO still remains a challenge, with ID still representing the first cause, and the main factors influencing the diagnostic categories are the income and the geographic position of the study country.
Journal ArticleDOI
Key diagnostic characteristics of fever of unknown origin in Japanese patients: a prospective multicentre study
Toshio Naito,Mika Tanei,Nobuhiro Ikeda,Toshihiro Ishii,Tomio Suzuki,Hiroyuki Morita,Sho Yamasaki,Jun'ichi Tamura,Kenichiro Akazawa,Koji Yamamoto,Hiroshi Otani,Satoshi Suzuki,Motoo Kikuchi,Shiro Ono,Hiroyuki Kobayashi,Hozuka Akita,Susumu Tazuma,Jun Hayashi +17 more
TL;DR: Age may be a key factor in the differential diagnosis of FUO; the ESR test may be of value in the FUOs evaluation process; these results may provide clinicians with insight into the management of F UO to allow adequate treatment according to the cause of the disease.
Journal ArticleDOI
Analysis of 256 cases of classic fever of unknown origin.
Masashi Yamanouchi,Yuki Uehara,Hirohide Yokokawa,Tomohiro Hosoda,Yukiko Watanabe,Takayoshi Shiga,Akihiro Inui,Yukiko Otsuki,Kazutoshi Fujibayashi,Hiroshi Isonuma,Toshio Naito +10 more
TL;DR: The present study identified diseases that should be considered in the differential diagnosis of FUO, providing useful information for the future diagnosis and treatment of F UO.
Journal ArticleDOI
Rheumatologic diseases as the cause of fever of unknown origin
TL;DR: The workup of FUO is based on the identification of potential diagnostic clues (PDCs), and in the absence of PDCs, a standardized diagnostic protocol should be followed, including early FDG-PET/CT.
References
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Book
Current Clinical Topics in Infectious Diseases
TL;DR: This work discusses nonmenstrual Toxic Shock Syndrome, human Immunodeficiency Virus Type 2: Human Biology of the Other AIDS Virus, and novel Plasmid-mediated B-Lactamases in Enterobacteriaceae: Emerging Problems for New B- lactam Antibiotics.