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Yıl 2019, Cilt: 5 Sayı: 6, 928 - 938, 04.11.2019
https://doi.org/10.18621/eurj.441463

Öz

Kaynakça

  • [1] Petersdorf RG, Beeson PB. Fever of unexplained origin: report on 100 cases. Medicine (Baltimore) 1961;40:1-30.
  • [2] Tolia J, Smith LG. Fever of unknown origin: historical and physical clues to making the diagnosis. Infect Dis Clin North Am 2007;21:917-36.
  • [3] Cunha BA. Fever of unknown origin: focused diagnostic approach based on clinical clues from the history, physical examination, and laboratory tests. Infect Dis Clin North Am 2007;21:1137-87.
  • [4] Mulders-Manders CM, Simon A, Bleeker-Rovers CP. Rheumatologic diseases as the cause of fever of unknown origin. Best Pract Res Clin Rheumatol 2016;30:789-801.
  • [5] Larson EB, Featherstone HJ, Petersdorf RG. Fever of undetermined origin: diagnosis and follow-up of 105 cases, 1970-1980. Medicine (Baltimore) 1982;61:269-92.
  • [6] de Kleijn EM, van Lier HJ, van der Meer JW. Fever of unknown origin (FUO). II. Diagnostic procedures in a prospective multicenter study of 167 patients. The Netherlands FUO Study Group. Medicine (Baltimore) 1997;76:401-14.
  • [7] Gaeta GB, Fusco FM, Nardiello S. Fever of unknown origin: a systematic review of the literature for 1995-2004. Nucl Med Commun 2006;27:205-11.
  • [8] Vanderschueren S, Knockaert D. Tackling fever and inflammation of unknown origin: the do's and don'ts. Acta Clin Belg 2014;69:412-17.
  • [9] Mourad O, Palda V, Detsky AS. A comprehensive evidence-based approach to fever of unknown origin. Arch Intern Med 2003;163:545-51.
  • [10] Cunha BA. Fever of unknown origin: clinical overview of classic and current concepts. Infect Dis Clin North Am 2007;21:867-915.
  • [11] Takeda R, Mizooka M, Kobayashi T, Kishikawa N, Yokobayashi K, Kanno K, et al. Key diagnostic features of fever of unknown origin: medical history and physical findings. J Gen Fam Med 2017;18:131-34.
  • [12] Cunha BA, Lortholary O, Cunha CB. Fever of unknown origin: a clinical approach. Am J Med 2015;128:1138.e1-1138.e15.
  • [13] De Kleijn EMHA, Vandenbroucke JP, Van Der Meer JWM, and The Netherlands FUO Study Group. Fever of unknown origin (FUO). I. A prospective multicenter study of 167 patients with FUO, using fixed epidemiologic entry criteria. Medicine (Baltimore) 1997;76:392-400.
  • [14] Bleeker-Rovers CP, Vos FJ, de Kleijn EM, Mudde AH, Dofferhoff TS, Richter C, et al. A prospective multicenter study on fever of unknown origin. the yield of a structured diagnostic protocol. Medicine (Baltimore) 2007;86:26-38.
  • [15] Iikuni Y, Okada J, Kondo H, Kashiwazaki S. Current fever of unknown origin 1982-1992. Intern Med 1994;33:67-73.
  • [16] Cruz Peña LA, Rodríguez Silva H, Pérez Caballero D. Fiebre de origen desconocido: Revisión de 105 pacientes. Rev Cubana Med 1995;34:1-10.
  • [17] Knockaert DC, Vanneste LJ, Vanneste SB, Bobbaers HJ. Fever of unknown origin in the 1980s. An update of the diagnostic spectrum. Arch Intern Med 1992;152:51-5.
  • [18] Durack DT, Street AC. Fever of unknown origin-reexamined and redefined. Curr Clin Top Infect Dis 1991;11:35-51.
  • [19] Marr KA. Actitud ante la fiebre y la sospecha de infección en el huésped inmunodeprimido. En: Goldman L, Schafer AI, editores. Cecil y Goldman. Tratado de Medicina Interna. 24a ed. Barcelona: Elsevier; 2013.p.1778-84.
  • [20] Hirschmann JV. Fever of unknown origin in adults. Clin Infect Dis 1997;24:291-302.
  • [21] Hot A, Schmulewitz L, Viard JP, Lortholary O. Fever of unknown origin in HIV/AIDS patients. Infect Dis Clin N Am 2007;21:1013-32.
  • [22] Knox TA, Wanke C. Gastrointestinal manifestations of HIV and AIDS. In: Goldman L, Schafer AI, editors. Goldman-Cecil Medicine. 25th ed. Philadelphia: Elsevier; 2016. p. 2302-5.
  • [23] Arnow PM, Flaherty JP. Fever of unknown origin. Lancet 1997;350:575-80.
  • [24] Cunha BA, Dieguez B, Varantsova A. Lessons learned from splenic infarcts with fever of unknown origin (FUO): culture-negative endocarditis (CNE) or malignancy? Eur J Clin Microbiol Infect Dis 2018;37:995-9.
  • [25] Cunha BA, Apostolopoulou A, Gian J. Fever of unknown origin (FUO) due to miliary BCG: The diagnostic importance of morning temperature spikes and highly elevated ferritin levels. Heart Lung 2017;46:205-7.
  • [26] Ellner JJ. Tuberculosis. In: Goldman L, Schafer AI, editors. Goldman-Cecil Medicine. 25th ed. Philadelphia: Elsevier; 2016.p.2030-9.
  • [27] Burzo ML, Antonelli M, Pecorini G, Favuzzi AMR, Landolfi R, Flex A. Fever of unknown origin and splenomegaly. A case report of blood culture negative endocarditis. Medicine (Baltimore) 2017;96:1-3.
  • [28] Sheon RP, Van Ommen RA. Fever of obscure origin: diagnosis and treatment based on a series of sixty cases. Am J Med 1963;34:486-99.
  • [29] Abba A, Khalil M. Clinical approach to lymphadenopathy. Ann Nigerian Med 2012;6:11-7.
  • [30] Sinclair S, Beckman E, Ellman L. Biopsy of enlarged superficial lymph nodes. JAMA 1974;228:602-3.
  • [31] Watts RA. How to investigate multisystem disease. Best Pract Res Clin Rheumatol 2014;28:831-43.
  • [32] Bofinger JJ, Schlossberg D. Fever of unknown origin caused by tuberculosis. Infect Dis Clin N Am 2007;21:947-62.
  • [33] Kim JH, Kim ES, Jun K-I, Jung Hg, Bang JH, Choe PG, et al. Delayed diagnosis of extrapulmonary tuberculosis presenting as fever of unknown origin in an intermediate-burden country. BMC Infect Dis.2018;18:426.
  • [34] Knockaert DC. Diagnostic strategy for fever of unknown origin in the ultrasonography and computed tomography era. Acta Clin Belg 1992;47:100-16.
  • [35] Knockaert DC, Vanneste LJ, Bobbaers HJ. Recurrent or episodic fever of unknown origin. Review of 45 cases and survey of the literature. Medicine (Baltimore) 1993;72:184-96.

Diagnostic utility of clinical and epidemiologic features in fever of unknown origin

Yıl 2019, Cilt: 5 Sayı: 6, 928 - 938, 04.11.2019
https://doi.org/10.18621/eurj.441463

Öz

Objectives:
To assess the diagnostic utility of clinical features in the major
diagnostic categories of Fever of unknown origin (FUO).

Methods: One hundred and thirty-three
patients meeting the classic criteria of FUO were included in the study. A
structured diagnostic protocol was used in all cases. Sensitivity, specificity,
positive and negative predictive values (PPV and NPVs), and likelihood ratios
of positive and negative tests (LR+ and LR-) were estimated with 95% confidence
intervals (95% CIs) for all clinical findings.

Results: Clinical and
epidemiologic features with best diagnostic utility indexes for the three major
diagnostic categories were: weight loss of 15 pounds or more (sensitivity,
68.4%, 95% CI:
52.33-84.52), pallor of the skin and mucous membranes
(sensitivity, 65.7%, 95% CI:
49.39-82.19), prior medical history
of cancer (PPV, 63.6%, 95% CI:
30.66-96.61; LR+, 4.38, 95% CI: 1.36-14.09),
lymphadenopathy (LR+, 2.2, 95% CI:
1.11-4.74), for neoplasms;
arthritis (PPV, 72%, 95% CI:
51.84-93.61), prior family history
of collagen diseases (PPV, 100%, 95% CI: 91.67-100.00), neurologic disorder (LR+,
5.1, 95% CI:
1.37-19.68), myalgia (LR+, 4.1, 95%
CI:
1.45-11.88) and skin lesions (LR+, 3.0, 95% CI: 1.51-6.22) for noninfectious
inflammatory diseases;
  weight loss of 15
pounds or more (sensitivity, 50%, 95% CI:
27.91-72.09), epidemiological
history of previous tuberculosis or tuberculosis exposure (LR+, 9.0, 95% CI:
1.76-46.77), and jaundice (LR+, 2.73, 95% CI: 0.7-10.63) for infections.







Conclusions: We identified clinical data
emerging from the anamnesis and physical examination that may help to guide the
diagnostic process in FUO.

Kaynakça

  • [1] Petersdorf RG, Beeson PB. Fever of unexplained origin: report on 100 cases. Medicine (Baltimore) 1961;40:1-30.
  • [2] Tolia J, Smith LG. Fever of unknown origin: historical and physical clues to making the diagnosis. Infect Dis Clin North Am 2007;21:917-36.
  • [3] Cunha BA. Fever of unknown origin: focused diagnostic approach based on clinical clues from the history, physical examination, and laboratory tests. Infect Dis Clin North Am 2007;21:1137-87.
  • [4] Mulders-Manders CM, Simon A, Bleeker-Rovers CP. Rheumatologic diseases as the cause of fever of unknown origin. Best Pract Res Clin Rheumatol 2016;30:789-801.
  • [5] Larson EB, Featherstone HJ, Petersdorf RG. Fever of undetermined origin: diagnosis and follow-up of 105 cases, 1970-1980. Medicine (Baltimore) 1982;61:269-92.
  • [6] de Kleijn EM, van Lier HJ, van der Meer JW. Fever of unknown origin (FUO). II. Diagnostic procedures in a prospective multicenter study of 167 patients. The Netherlands FUO Study Group. Medicine (Baltimore) 1997;76:401-14.
  • [7] Gaeta GB, Fusco FM, Nardiello S. Fever of unknown origin: a systematic review of the literature for 1995-2004. Nucl Med Commun 2006;27:205-11.
  • [8] Vanderschueren S, Knockaert D. Tackling fever and inflammation of unknown origin: the do's and don'ts. Acta Clin Belg 2014;69:412-17.
  • [9] Mourad O, Palda V, Detsky AS. A comprehensive evidence-based approach to fever of unknown origin. Arch Intern Med 2003;163:545-51.
  • [10] Cunha BA. Fever of unknown origin: clinical overview of classic and current concepts. Infect Dis Clin North Am 2007;21:867-915.
  • [11] Takeda R, Mizooka M, Kobayashi T, Kishikawa N, Yokobayashi K, Kanno K, et al. Key diagnostic features of fever of unknown origin: medical history and physical findings. J Gen Fam Med 2017;18:131-34.
  • [12] Cunha BA, Lortholary O, Cunha CB. Fever of unknown origin: a clinical approach. Am J Med 2015;128:1138.e1-1138.e15.
  • [13] De Kleijn EMHA, Vandenbroucke JP, Van Der Meer JWM, and The Netherlands FUO Study Group. Fever of unknown origin (FUO). I. A prospective multicenter study of 167 patients with FUO, using fixed epidemiologic entry criteria. Medicine (Baltimore) 1997;76:392-400.
  • [14] Bleeker-Rovers CP, Vos FJ, de Kleijn EM, Mudde AH, Dofferhoff TS, Richter C, et al. A prospective multicenter study on fever of unknown origin. the yield of a structured diagnostic protocol. Medicine (Baltimore) 2007;86:26-38.
  • [15] Iikuni Y, Okada J, Kondo H, Kashiwazaki S. Current fever of unknown origin 1982-1992. Intern Med 1994;33:67-73.
  • [16] Cruz Peña LA, Rodríguez Silva H, Pérez Caballero D. Fiebre de origen desconocido: Revisión de 105 pacientes. Rev Cubana Med 1995;34:1-10.
  • [17] Knockaert DC, Vanneste LJ, Vanneste SB, Bobbaers HJ. Fever of unknown origin in the 1980s. An update of the diagnostic spectrum. Arch Intern Med 1992;152:51-5.
  • [18] Durack DT, Street AC. Fever of unknown origin-reexamined and redefined. Curr Clin Top Infect Dis 1991;11:35-51.
  • [19] Marr KA. Actitud ante la fiebre y la sospecha de infección en el huésped inmunodeprimido. En: Goldman L, Schafer AI, editores. Cecil y Goldman. Tratado de Medicina Interna. 24a ed. Barcelona: Elsevier; 2013.p.1778-84.
  • [20] Hirschmann JV. Fever of unknown origin in adults. Clin Infect Dis 1997;24:291-302.
  • [21] Hot A, Schmulewitz L, Viard JP, Lortholary O. Fever of unknown origin in HIV/AIDS patients. Infect Dis Clin N Am 2007;21:1013-32.
  • [22] Knox TA, Wanke C. Gastrointestinal manifestations of HIV and AIDS. In: Goldman L, Schafer AI, editors. Goldman-Cecil Medicine. 25th ed. Philadelphia: Elsevier; 2016. p. 2302-5.
  • [23] Arnow PM, Flaherty JP. Fever of unknown origin. Lancet 1997;350:575-80.
  • [24] Cunha BA, Dieguez B, Varantsova A. Lessons learned from splenic infarcts with fever of unknown origin (FUO): culture-negative endocarditis (CNE) or malignancy? Eur J Clin Microbiol Infect Dis 2018;37:995-9.
  • [25] Cunha BA, Apostolopoulou A, Gian J. Fever of unknown origin (FUO) due to miliary BCG: The diagnostic importance of morning temperature spikes and highly elevated ferritin levels. Heart Lung 2017;46:205-7.
  • [26] Ellner JJ. Tuberculosis. In: Goldman L, Schafer AI, editors. Goldman-Cecil Medicine. 25th ed. Philadelphia: Elsevier; 2016.p.2030-9.
  • [27] Burzo ML, Antonelli M, Pecorini G, Favuzzi AMR, Landolfi R, Flex A. Fever of unknown origin and splenomegaly. A case report of blood culture negative endocarditis. Medicine (Baltimore) 2017;96:1-3.
  • [28] Sheon RP, Van Ommen RA. Fever of obscure origin: diagnosis and treatment based on a series of sixty cases. Am J Med 1963;34:486-99.
  • [29] Abba A, Khalil M. Clinical approach to lymphadenopathy. Ann Nigerian Med 2012;6:11-7.
  • [30] Sinclair S, Beckman E, Ellman L. Biopsy of enlarged superficial lymph nodes. JAMA 1974;228:602-3.
  • [31] Watts RA. How to investigate multisystem disease. Best Pract Res Clin Rheumatol 2014;28:831-43.
  • [32] Bofinger JJ, Schlossberg D. Fever of unknown origin caused by tuberculosis. Infect Dis Clin N Am 2007;21:947-62.
  • [33] Kim JH, Kim ES, Jun K-I, Jung Hg, Bang JH, Choe PG, et al. Delayed diagnosis of extrapulmonary tuberculosis presenting as fever of unknown origin in an intermediate-burden country. BMC Infect Dis.2018;18:426.
  • [34] Knockaert DC. Diagnostic strategy for fever of unknown origin in the ultrasonography and computed tomography era. Acta Clin Belg 1992;47:100-16.
  • [35] Knockaert DC, Vanneste LJ, Bobbaers HJ. Recurrent or episodic fever of unknown origin. Review of 45 cases and survey of the literature. Medicine (Baltimore) 1993;72:184-96.
Toplam 35 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Bulaşıcı Hastalıklar, İç Hastalıkları
Bölüm Original Article
Yazarlar

Victor Roca Campañá 0000-0002-8346-6521

Rosa Eugenia Jiménez Paneque Bu kişi benim 0000-0001-9647-3061

Héctor Manuel Rodríguez Silva Bu kişi benim 0000-0002-3648-2609

Yayımlanma Tarihi 4 Kasım 2019
Gönderilme Tarihi 7 Temmuz 2018
Kabul Tarihi 4 Temmuz 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 5 Sayı: 6

Kaynak Göster

AMA Campañá VR, Paneque REJ, Silva HMR. Diagnostic utility of clinical and epidemiologic features in fever of unknown origin. Eur Res J. Kasım 2019;5(6):928-938. doi:10.18621/eurj.441463

e-ISSN: 2149-3189 


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