Diagnostic Value of PCT and CRP for Detecting Serious Bacterial Infections in Patients With Fever of Unknown Origin

Fluorodesoxyglucose Positron Emission Tomography (PET/CT) has never been compared to Chest-Abdomen-Pelvis CT (CAPCT) in patients with a fever of unknown origin (FUO), inflammation of unknown origin (IUO) and episodic fever of unknown origin (EFUO) through a prospective and multicentre study. In this study, we investigated the diagnostic value of PET/CT compared to CAPCT in these patients. The trial was performed between 1 May 2008 through 28 February 2013 with 7 French University Hospital centres. Patients who fulfilled the FUO, IUO or EFUO criteria were included. Diagnostic orientation (DO), diagnostic contribution (DC) and time for diagnosis of both imaging resources were evaluated. One hundred and three patients were included with 35 FUO, 35 IUO and 33 EFUO patients. PET/CT showed both a higher DO (28.2% vs. 7.8%, p < 0.001) and DC (19.4% vs. 5.8%, p < 0.001) than CAPCT and reduced the time for diagnosis in patients (3.8 vs. 17.6 months, p = 0.02). Arthralgia (OR 4.90, p = 0.0012), DO of PET/CT (OR 4.09, p = 0.016), CRP > 30 mg/L (OR 3.70, p = 0.033), and chills (OR 3.06, p = 0.0248) were associated with the achievement of a diagnosis (Se: 89.1%, Sp: 56.8%). PET/CT both orients and contributes to diagnoses at a higher rate than CAPCT, especially in patients with FUO and IUO, and reduces the time for diagnosis.

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Fever of unknown origin: prospective comparison of diagnostic value of 18F-FDG PET and 111In-granulocyte scintigraphy

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-004-1634-6 ◽

2004 ◽

Vol 31 (9) ◽

pp. 1342-1343 ◽

Cited By ~ 9

Author(s):

Chantal P. Bleeker-Rovers ◽

Frans H. M. Corstens ◽

Jos W. M. van der Meer ◽

Wim J. G. Oyen

Keyword(s):

Fdg Pet ◽

Fever Of Unknown Origin ◽

Unknown Origin ◽

Diagnostic Value ◽

Prospective Comparison ◽

18F Fdg ◽

Granulocyte Scintigraphy

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

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1520 ◽

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.

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Diagnostic value of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography in patients with fever of unknown origin—Reply

European Journal of Internal Medicine ◽

10.1016/j.ejim.2011.08.010 ◽

2011 ◽

Vol 22 (6) ◽

pp. e150

Author(s):

Zi-Ke Sheng ◽

Jun-Jie Li ◽

Kui Zhao ◽

Ji-Fang Sheng

Keyword(s):

Computed Tomography ◽

Positron Emission Tomography ◽

Fever Of Unknown Origin ◽

Unknown Origin ◽

Diagnostic Value ◽

Emission Tomography ◽

Fluorodeoxyglucose Positron Emission Tomography ◽

Positron Emission ◽

Fluorine 18 Fluorodeoxyglucose ◽

Fluorodeoxyglucose Positron Emission

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Patients with Fever of Unknown Origin and Splenomegaly: Diagnostic Value of Splenectomy and Preoperative Risk Factors Suggestive of Underlying Lymphomas

Acta Haematologica ◽

10.1159/000473859 ◽

2017 ◽

Vol 137 (4) ◽

pp. 240-246

Author(s):

Lu Zhang ◽

Wei Zhang ◽

Huacong Cai ◽

Xinxin Cao ◽

Miao Chen ◽

...

Keyword(s):

Risk Factors ◽

Lymph Nodes ◽

Hodgkin Lymphoma ◽

Fever Of Unknown Origin ◽

Characteristic Curve ◽

Unknown Origin ◽

Final Diagnosis ◽

Diagnostic Value ◽

Discrimination Power ◽

Non Hodgkin Lymphoma

Background: We reviewed patients with fever of unknown origin (FUO) and splenomegaly and assessed the diagnostic value of splenectomy and measured risk factors suggestive of an underlying lymphoma. Methods: FUO patients (n = 83) who had splenomegaly and underwent splenectomy were enrolled into this retrospective single-center study. Clinical presentations were documented and risk factors suggestive of an underlying lymphoma were tested. Results: Seventy-four patients (89.2%) had a diagnosis of lymphoma or not after splenectomy and follow-up. Of those (55.4%) diagnosed with lymphoma, 29 had B-cell non-Hodgkin lymphoma and 12 had T-cell non-Hodgkin lymphoma. The remaining 33 (44.6%) had diseases other than lymphoma. Using multivariate logistic analysis, the following 3 independent risk factors were found to be related to a final diagnosis of lymphoma: age (continuous) (HR 1.086; 95% CI 1.033-1.141; p = 0.001), massively enlarged spleen (HR 7.797; 95% CI 1.267-47.959; p = 0.027), and enlarged intra-abdominal lymph nodes (HR 63.925; 95% CI 7.962-513.219; p < 0.001). The calibration of the model was satisfactory (p = 0.248 using the Hosmer-Lemeshow test), and the discrimination power was good (area under the receiver operating characteristic curve 0.925; 95% CI 0.863-0.987). Conclusions: Splenectomy is an effective diagnostic procedure for patients with FUO and splenomegaly and lymphoma is a common cause. Older age, a massively enlarged spleen, and enlarged intra-abdominal lymph nodes are risk factors suggesting an underlying lymphoma, and surgery for high-risk patients should be considered.

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