scholarly journals Classical Fever of Unknown Origin: Retrospective Study in Infectious Clinical Hospital №2

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S343-S343
Author(s):  
Nikolay Lunchenkov ◽  
Eugene Filippov ◽  
Olga Prihodko ◽  
Elena Volchkova
Keyword(s):  
Infective Endocarditis ◽  
Infectious Diseases ◽  
Bacterial Infection ◽  
Clinical Data ◽  
Fever Of Unknown Origin ◽  
Inflammatory Diseases ◽  
Connective Tissue Diseases ◽  
Unknown Origin ◽  
Axillary Temperature ◽  
Clinical Hospital

Abstract Background Despite the recent advances in medicine, fever of unknown origin (FUO) remains a diagnostic and therapeutic challenge even to expert physicians. The etiological structure of FUO is determined by many factors, including the one where a person lived and where has been hospitalized. The aim of this study is to investigate the etiology and clinical characteristics of adult classical FUO with more diagnostics available and to analyze the factors for certain disease categories. Methods The clinical data were retrospectively analyzed from 80 patients with cFUO hospitalized at the Infectious Clinical Hospital №2 between October 2015 and October 2016 the patients who met the D.Durack criteria (1) An axillary temperature of >38.0 which corresponds oral temperature of >38.3; (2) illness duration is more than 3 weeks; (3) there is no definite diagnosis after three outpatient visits or 3 days in the hospital with intensive investigations; (4) the fever is not related to FUO of other groups: nosocomial FUO, FUO in patients with AIDS, neutropenia were included. Results Of the 80 FUO cases, 70 were positively diagnosed with a diagnosis rate of 87,5%. Infectious diseases were still the primary causes of FUO 63% (n = 50). Among them the most frequent diagnoses were bacterial infection of unspecified site 12.5%
(n = 10), infective endocarditis 11% (n = 9), as well as pneumonia 7.5% (n = 6) and viral infections of unspecified site 7.5% (n=6). Connective tissue diseases and other noninfectious inflammatory diseases accounted for 17.5% of the FUO cases among which SLE and autoimmune thyroiditis were the most common etiologies and made up 5% (n = 4) and 3,75% (n = 3), respectively. Neoplasms were 8% (n = 6) in our sample. Also ten patients (12,5%) could not be confirmed until they were discharged from hospital. Conclusion Infectious diseases are the major causes of FUO, and the most common cause is bacterial infection of unspecified site. To determine the etiology was difficult due to the limited conditions of the clinical hospital. Infectious endocarditis was found on the second place. The most common causative agents of infective endocarditis were MRSA (3/9) и streptococcus viridans (4/9). The frequency of undiagnosed cases was increasing, but in most FUO cases the causes can be diagnosed eventually after careful analysis of clinical data. Disclosures All authors: No reported disclosures.

scholarly journals Diagnostic Use of Serum Ferritin Levels to Differentiate Infectious and Noninfectious Diseases in Patients with Fever of Unknown Origin

2013 ◽  
Vol 34 (3) ◽  
pp. 211-218 ◽  
Author(s):  
Seong Eun Kim ◽  
Uh Jin Kim ◽  
Mi Ok Jang ◽  
Seung Ji Kang ◽  
Hee Chang Jang ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Infectious Diseases ◽  
Serum Ferritin ◽  
Fever Of Unknown Origin ◽  
Inflammatory Diseases ◽  
Unknown Origin ◽  
University Hospital ◽  
Disease Group ◽  
Hematologic Disease ◽  
Hematologic Diseases

INTRODUCTION: In this study, we determined whether serum ferritin levels could be used to differentiate between fever of unknown origin (FUO) caused by infectious and noninfectious diseases.METHODS: FUO patients were hospitalized at Chonnam National University Hospital between January, 2005 and December, 2011. According to the final diagnoses, five causes were identified, including infectious diseases, hematologic diseases, noninfectious inflammatory diseases, miscellaneous and undiagnosed.RESULTS: Of the 77 patients, 11 were caused by infectious diseases, 13 by hematologic diseases, 20 by noninfectious inflammatory diseases, 8 by miscellaneous diseases, and 25 were undiagnosed. The median serum ferritin levels in infectious diseases was lower than those in hematologic diseases and (median (interquartile range) of 282.4 (149.0–951.8) ng/mL for the infectious disease group, 1818.2 (485.4–4789.5) ng/mL for the hematologic disease group, and 563.7 (399.6–1927.2) ng/mL for the noninfectious inflammatory disease group,p= 0.048, Kruskal–Wallis test). By comparison using the Mann–Whitney test, statistically significant differences were found only between the infectious disease and hematologic disease groups (p= 0.049) and between the infectious disease and groups (p= 0.04).CONCLUSION: An optimal cutoff value of serum ferritin levels to predict FUO caused by a noninfectious disease (hematologic diseases, noninfectious inflammatory diseases) was established as 561 ng/mL.

Infective endocarditis as a complication of longstanding ventriculoatrial (VA) shunt: the importance of suspicion and early investigation in patients with VA shunt and pyrexia of unknown origin

2021 ◽  
Vol 14 (1) ◽  
pp. e237161
Author(s):  
Rosa Sun ◽  
Richard Warwick ◽  
Stuart Harrisson ◽  
Nageswar Bandla
Keyword(s):  
Infective Endocarditis ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Early Investigation ◽  
Window Of Opportunity ◽  
Pyrexia Of Unknown Origin ◽  
Cerebrospinal Fluid Diversion ◽  
Prompt Diagnosis

Ventriculoatrial (VA) shunts are a method of cerebrospinal fluid diversion, which nowadays are infrequently seen in medical practice. Infective endocarditis (IE) can occur as rare complications of VA shunts, through the introduction of a foreign body close to the tricuspid valve. We report a case of infective endocarditis, that is, in a patient with VA shunt for congenital hydrocephalus. We present the case to highlight the importance of early investigation for IE in patients with fever of unknown origin and shunt in situ, as rapid deterioration can occur and be fatal. We also discuss past experience reported in the literature on the role of cardiothoracic intervention. Prompt diagnosis and early cardiothoracic referral for surgery are crucial, there may only be a narrow window of opportunity for intervention before patients develop fulminant sepsis.

Utility of a Simple Scoring System in Differentiating Bacterial Infections in Cases of Fever of Unknown Origin

2020 ◽  
Vol 71 (Supplement_4) ◽  
pp. S409-S415
Author(s):  
Teng Xu ◽  
Li Wang ◽  
Shi Wu ◽  
Fenfen Zhou ◽  
Haihui Huang
Keyword(s):  
Bacterial Infection ◽  
Roc Curve ◽  
Scoring System ◽  
Inflammatory Markers ◽  
Retrospective Cohort ◽  
Bacterial Infections ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Neutrophil Percentage ◽  
Serum Inflammatory Markers

Abstract Background Infectious disease is the leading cause of fever of unknown origin (FUO). Serum inflammatory markers historically used to diagnose bacterial infection have sufficient diagnostic sensitivity but low specificity. This study aimed to develop a simple scoring system for differentiating bacterial infections from other causes of early-stage FUO. Methods This study included a retrospective cohort of patients presenting with FUO at the Huashan Hospital (January 2014 to June 2017). The diagnostic utility of serum inflammatory markers for bacterial infection was evaluated using the receiver operating characteristic (ROC) curve analysis. Relevant markers were subsequently measured prospectively in a separate cohort of FUO patients (December 2017 to May 2019). A scoring system was based on inflammatory markers and other test results. Results Bacterial infection was identified in 34% of patients in the retrospective cohort. The area under the ROC curve (AUC) was 0.644 (95% confidence interval [CI], .595–.693) for C-reactive protein, 0.624 (95% CI, .573–.675) for procalcitonin, and 0.646 (95% CI, .595–.697) for serum ferritin (SF) in diagnosing bacterial infection. Bacterial infection was found in 29% of cases in the prospective cohort. A model based on serum amyloid A (SAA) and SF levels and neutrophil percentage yielded an AUC of 0.775 (95% CI, .695–.854). Validation analysis indicated lower probability (<15%) of bacterial infection for patients with a score <16.5 points. Conclusions A scoring system based on SAA and SF levels and neutrophil percentage can help distinguish bacterial infection from other causes of FUO, potentially reducing antibiotic use.

Infectious diseases and emergencies

2016 ◽  
Author(s):  
Dr Nicholas Price ◽  
Dr John L Klein
Keyword(s):  
Infectious Diseases ◽  
Fever Of Unknown Origin ◽  
Fungal Infections ◽  
Unknown Origin ◽  
Antibiotic Use ◽  
Skin Lesions ◽  
Toxic Shock ◽  
Febrile Patient ◽  
Device Associated Infection ◽  
Hospital Acquired

Chapter 6 covers infectious diseases and emergencies, including clinical features, history, and examination, the febrile patient with skin lesions or rash, hospital-acquired (nosocomial), infections, classic viral exanthems and mumps, ‘mononucleosis’ syndromes, fungal infections, fever in the returning traveller, fever of unknown origin (FUO), principles and practice of antibiotic use, public health aspects of infectious disease, malaria, meningococcal disease, infections in pregnancy, vascular access device-associated infection, and toxic shock syndrome.

Fever of unknown origin caused by infectious diseases in the era of migrant and refugee crisis

2020 ◽  
Vol 33 ◽  
pp. 101425
Author(s):  
Nikolaos Spernovasilis ◽  
Constantinos Tsioutis ◽  
Lamprini Markaki ◽  
Maria Zafeiri ◽  
Stella Soundoulounaki ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Refugee Crisis

scholarly journals Fever of unknown origin as the major manifestation of subacute thyroiditis

2021 ◽  
Vol 2021 ◽  
Author(s):  
Ahmad Housin ◽  
Marc P Pusztaszeri ◽  
Michael Tamilia
Keyword(s):  
Fever Of Unknown Origin ◽  
Connective Tissue Diseases ◽  
Unknown Origin ◽  
Signs And Symptoms ◽  
Medical Problem ◽  
Subacute Thyroiditis ◽  
Endocrine Disorders ◽  
List Type ◽  
Thyroid Function Tests ◽  
Markers Of Inflammation

Summary Fever of unknown origin is a commonly encountered medical problem. Most common causes include infections, malignancy, and connective tissue diseases. Endocrine causes are rare but are well documented. While fever is common in some endocrine disorders, fever of unknown origin as the sole presenting feature is very rare. We describe a case report of a 63-year-old male who presents with fever of unknown origin. Imaging and biopsy results confirmed the diagnosis of subacute thyroiditis. He was started on prednisone with a good response. We conclude that subacute thyroiditis should be considered in the work up of fever of unknown origin even in the absence of classical signs and symptoms. Learning points Fever of unknown origin is a rare sole presentation of subacute thyroiditis. The classic signs and symptoms may not be manifest at the time of presentation. Normal thyroid function tests and elevated markers of inflammation often make infections, malignancy and autoinflammatory conditions the prime consideration. Imaging of the thyroid gland may point to a morphologic aberration and prompt a thyroid biopsy. After exclusion of infection, a rapid response to steroids may be both diagnostic and therapeutic.

scholarly journals A study of etiology of fever of unknown origin in children aged 2 months to 18 years

2021 ◽  
Vol 8 (11) ◽  
pp. 1842
Author(s):  
Naveen Gandla ◽  
Sheela A. Bharani ◽  
Tushar P. Shah
Keyword(s):  
Enteric Fever ◽  
Fever Of Unknown Origin ◽  
Lymphoblastic Leukemia ◽  
Connective Tissue Diseases ◽  
Unknown Origin ◽  
Age Group ◽  
Antimicrobial Drugs ◽  
Cross Sectional ◽  
Female Ratio ◽  
Geographical Regions

Background: In an era of advance science of modern technologies, many diseases are diagnosed and excluded rapidly and now Fever of Unknown Origin (FUO) has been redefined for any fever of 380C lasting for more than 7 days without any clear cause. The aetiology varies according to different geographical regions, socioeconomical status, age, prevalence of resistance to antimicrobial drugs and genetic susceptibility.Methods: It was a descriptive cross sectional, hospital-based study, carried out on 150 children from August 2018 to May 2020. All cases in the age group of 2 months to 18 years with fever of >38.0°C, lasting for more than 7 days without a clear source were included.Results: The mean age of presentation was 5.8 years±Standard Deviation of 3.7 years with male to female ratio was 1.4:1. Nearly half of the cases, presented with the duration of fever between 8-14 days. Enteric fever in 52%, tuberculosis in 13.3% and acute lymphoblastic leukemia (ALL) in 8.5% were three common etiologies found in this study. Amongst all cases of FUO, infective causes were seen in 113 (75.3%) followed by malignancies in 15(10%) cases. In 10 (6.7%) cases, cause could not be established.Conclusions: Enteric fever and tuberculosis were the leading etiologies from infective subgroup of FUO. ALL was the commonest cause from malignancies sub group. FUO presenting with low haemoglobin, platelet is a pointer towards malignancy. Occurrence of FUO with infectious diseases and malignancies was found in younger age group as compared to connective tissue diseases. 

scholarly journals Prevalence of Connective Tissue Diseases in Egyptian Patients Presenting with Fever of Unknown Origin

2011 ◽  
Vol 4 ◽  
pp. CMAMD.S6763 ◽  
Author(s):  
Mohamad S. Abdelbaky ◽  
Howaida E. Mansour ◽  
Shafika I. Ibrahim ◽  
Iman A. Hassan
Keyword(s):  
Connective Tissue ◽  
Fever Of Unknown Origin ◽  
Urine Analysis ◽  
Complete Blood Count ◽  
Connective Tissue Diseases ◽  
Unknown Origin ◽  
Medical Problem ◽  
Advanced Technology ◽  
Diagnostic Tools ◽  
History Taking

Objective To estimate the prevalence of connective tissue diseases in patients presenting with fever of unknown origin (FUO). Patients and Methods In this study thirty patients diagnosed as FUO (Group 1), in 2008, were included in an observational study and diagnostic workup. Additionally, retrospective analysis of seventy patients’ files (Group 2), for patients who presented with prolonged unexplained pyrexia to the same hospital in the previous two years, was performed. Patients were subjected to: full clinical assessment including full history taking, thorough clinical examination, laboratory investigations including the basic investigations for patients with prolonged fever, complete blood count, erythrocytes sedimentation rate, urine analysis and culture, blood culture, sputum culture and plain chest X ray. Further diagnostic work up and/or procedures were requested according to the potential diagnostic clues (PDC) present in every patient. Results Out of 100 FUO patients, 50% were found to have infectious diseases, 24% were found to have connective tissue diseases, 8% miscellaneous causes and 7% neoplastic diseases ( P < 0.05). In 11 patients no definite cause for FUO could be identified. Connective tissue patients were: eight systemic lupus patients (33.3%), five patients with familial mediterranean fever (20.8%), four patients with rheumatoid arthritis (16.6%), three patients (12.5%) with Still's disease and Rheumatic fever and one patient with Behçet syndrome/Crohn's disease (4.3%), ( P < 0.05). Conclusions Despite the advanced technology, FUO remains a challenging medical problem. Infections were the most common cause of FUO in Egypt, confirming the trends found in other parts of the world. There was an increased prevalence of connective tissue patients presented with prolonged unexplained fever. A keen clinical eye, meticulous history taking and repeated physical examination remained the most important diagnostic tools in FUO patients.

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