Dataset Information

Diagnostic workup for fever of unknown origin: a multicenter collaborative retrospective study.

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.

SUBMITTER: Naito T

PROVIDER: S-EPMC3884594 | biostudies-literature | 2013 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Diagnostic workup for fever of unknown origin: a multicenter collaborative retrospective study.

Naito Toshio T Mizooka Masafumi M Mitsumoto Fujiko F Kanazawa Kenji K Torikai Keito K Ohno Shiro S Morita Hiroyuki H Ukimura Akira A Mishima Nobuhiko N Otsuka Fumio F Ohyama Yoshio Y Nara Noriko N Murakami Kazunari K Mashiba Kouichi K Akazawa Kenichiro K Yamamoto Koji K Senda Shoichi S Yamanouchi Masashi M Tazuma Susumu S Hayashi Jun J

BMJ open 20131220 12

<h4>Objective</h4>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.<h4>Design</h4>A nationwide retrospective study.<h4>Setting</h4>17 hospitals affiliated with the Japanese Society of Hospital General Medicine.<h ...[more]

PMID: 24362014

Similar Datasets

Project description:BackgroundIn patients with fever or inflammation of unknown origin (fever of unknown origin [FUO] or inflammation of unknown origin [IUO], respectively), expert consensus recommends the use of positron emission tomography with fluorine-18-fluorodeoxy glucose combined with computed tomography (FDG-PET/CT) when standard work-up fails to identify diagnostic clues. However, the clinical variables associated with successful localization of the cause by FDG-PET/CT remain uncertain. Moreover, the long-term outcomes of patients with unexplained FUO or IUO after negative FDG-PET/CT results are unknown. Therefore, we assessed predictors of successful diagnosis of FUO or IUO caused by FDG-PET/CT and associations of spontaneous remission of symptoms with FDG-PET/CT results.MethodsAll patients with FUO or IUO, who underwent FDG-PET/CT from 2013 to 2019 because diagnostic work-up failed to identify a cause, were retrospectively included. We calculated the diagnostic yield and performed multivariable logistic regression to assess characteristics previously proposed to be associated with successful localization of FUO or IUO causes. We also assessed whether the FDG-PET/CT results were associated with spontaneous remissions.ResultsIn total, 50 patients with diagnostically challenging FUO or IUO (35 with FUO and 15 with IUO) were assessed. Other than one case of infection, all the identified causes were either malignancy or non-infectious inflammatory diseases (each with 18 patients), and FDG-PET/CT correctly localized the cause in 29 patients (diagnostic yield = 58%). None of the proposed variables was associated with successful localization. All 13 patients with sustained unexplained cause remained alive (median follow-up, 190 days). Spontaneous remission was observed in 4 of 5 patients with a negative FDG-PET/CT, and 1 of 8 with a positive result (P = 0.018).ConclusionIn the current cohort, the proposed variables were not predictive for successful localization by FDG-PET/CT. A negative FDG-PET/CT scan may be prognostic for spontaneous remission in patients with sustained FUO or IUO.

Dataset Information

Diagnostic workup for fever of unknown origin: a multicenter collaborative retrospective study.

Objective

Design

Setting

Participants

Results

Conclusions

Publications

Diagnostic workup for fever of unknown origin: a multicenter collaborative retrospective study.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets