Fever of Unknown Origin

Yıl 2014, Cilt: 4 Sayı: 2, 104 - 108, 01.06.2014

Tezcan Kaya Ali Tamer

https://doi.org/10.5505/sakaryamj.2014.99710

Öz

Classic fever of unknown origin (FUO) is defined as the occurrence of a body temperature greater than 38.3°C on several occasions; a duration of fever greater than three weeks; and failure to reach a diagnosis despite one week of inpatient investigation. Etiologic assessment of FUO cases should primarily include a detailed history and physical examination. Laboratory tests, imaging techniques, and invasive procedures such as biopsy are then performed to achieve a diagnosis. Most etiologies of FUO are categorized into the following five groups: infections, malignancies, noninfectious inflammatory diseases, miscellaneous causes, and undiagnosed. The most commonly reported infectious disease etiologies were abscess, tuberculosis, endocarditis, and brucellosis. Adult Still's disease was reported as the most common noninfectious inflammatory disease and lymphoma was the most common malignancy. This review discusses the diagnostic approaches taken for cases of classic FUO and commonly reported etiologies of FUO.

Anahtar Kelimeler

Fever of unknown origin, fever; tuberculosis; lymphoma

Nedeni Bilinmeyen Ateş

Öz

Klasik nedeni bilinmeyen ateş (NBA) birden fazla ölçümde 38,3 ºC'yi geçen, 3 haftadan uzun süredir devam eden ve bir haftalık hastanede yatarak araştırılmasına rağmen tanı konamayan ateşi olan olgular şeklinde tanımlanır. NBA olgusunun etyolojik araştırmasında öncelikle ayrıntılı anamnez ve fizik muayene yapılmalıdır. Daha sonra laboratuvar tetkikleri, görüntüleme yöntemleri ve biyopsi gibi invaziv işlemlerle tanıya ulaşılmaya çalışılır. NBA'ın en sık etyolojileri genellikle enfeksiyon hastalıkları, malign hastalıklar, enfeksiyon dışı inflamatuar hastalıklar, diğer tanılar ve tanı koyulamayanlar olmak üzere beş grup altında toplanmıştır. Enfeksiyöz nedenlerinden en sık bildirilenler apse, tüberküloz, infektif endokardit ve brusellozdur. Enfeksiyon dışı inflamatuar hastalıklardan en sık erişkin Still hastalığı ve malignitelerden en sık lenfomalar bildirilmiştir. Bu yazıda klasik NBA olgularına tanısal yaklaşım ve NBA'nın sık bildirilen etyolojileri tartışılmıştır.

Anahtar Kelimeler

Nedeni bilinmeyen ateş, ateş; tüberküloz; lenfoma

Kaynakça

• Petersdorf RG, Beeson PB. Fever of unknown origin: report on 100 cases. Medicine 1961;40:1–30.
• Durack DT, Street AC. Fever of unknown origin reexamined and redefined. Curr Clin Top Infect Dis 1991;11:35–51.
• Mackowiak PA, Durack DT. Fever of unknown origin. In: Mandell GL, Bennet JE, Dolin R, editors. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. London: Churchill Livingstone; 2009. P. 779- 89.
• Kucukardali Y, Oncul O, Cavuslu O, et al. The spectrum of diseases causing fever of unknown origin in Turkey: a multicenter study Fever of Unknown Origin Study Group Int J Infect Dis 2008;12:71-79.
• Gaeta GB, Fusco FM, Nardiello S. Fever of unknown origin: a systematic review of the literature for 1995-2004. Nucl Med Commun 2006;27(3):205- 11.
• Cunha BA. Fever of unknown origin: clinical overview of classic and current conceptsInfect Dis Clin N Am 2007;21(4):867–915.
• 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.
• Hayakawa K, Ramasamy B, Chandrasekar PH. Fever of unknown origin: an evidence-based review. Am J Med Sci 2012;344(4):307-16.
• Musher DM, Fainstein V, Young EJ, et al. Fever patterns. Their lack of clinical significance. Arch Intern Med 1979;139:1225-8.
• Horsburgh CR Jr, Mason UG 3rd, Farhi DC, Iseman MD. Disseminated infection with Mycobacterium avium-intracellulare. A report of 13 cases and a review of the literature. Medicine (Baltimore) 1985;64(1):36-48.
• Assi MA, Sandid MS, Baddour LM, Roberts GD, Walker RC. Systemic histoplasmosis: a 15-year retrospective institutional review of 111 patients. Medicine (Baltimore) 2007;86(3):162-9.
• Amin K, Kauffman CA. Fever of unknown origin. A strategic approach to this diagnostic dilemma. Postgrad Med 2003;114(3):69-75.
• Mourad O, Palda V, Detsky AS. A comprehensive evidence-based approach to fever of unknown origin. Arch Intern Med. 2003;163(5):545-51.
• 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(1):26-38.
• Kleijn EM, Lier HJ, 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(6):401-14.
• Arnow PM, Flaherty JP. Fever of unknown origin. Lancet 1997; 350: 575- 80.
• Becker W, Meller J.The role of nuclear medicine in infection and inflammation. Lancet Infect Dis. 2001;1(5):326-33.
• Bleeker-Rovers CP, Vos FJ, Mudde AH, Dofferhoff AS, de Geus-Oei LF, Rijnders AJ, et al. A prospective multi-centre study of the value of FDG- PET as part of a structured diagnostic protocol in patients with fever of unknown origin. Eur J Nucl Med Mol Imaging 2007;34(5):694-703.
• Dorfman RF, Remington JS. Value of lymph-node biopsy in the diagnosis of acute acquired toxoplasmosis. N Engl J Med 1973;289:878-81.
• Tsang WY, Chan JK, Ng CS. Kikuchi's lymphadenitis. A morphologic analysis of 75 cases with special reference to unusual features. Am J Surg Pathol 1994;18:219-31.
• Holtz T, Moseley RH, Scheiman JM. Liver biopsy in fever of unknown origin. A reappraisal. J Clin Gastroenterol 1993;17:29-32.
• Hot A, Jaisson I, Girard C, French M, Durand DV, Rousset H, Ninet J. Yield of bone marrow examination in diagnosing the source of fever of unknown origin. Arch Intern Med. 2009;169:2018-23.
• Volk EE, Miller ML, Kirkley BA, Washington JA. The diagnostic usefulness of bone marrow cultures in patients with fever of unknown origin. Am J Clin Pathol 1998;110:150-3.
• Sipahi OR, Senol S, Arsu G, Pullukcu H, Tasbakan M, Yamazhan T, ArdaB, Ulusoy S. Pooled analysis of 857 published adult fever of unknown origin cases in Turkey between 1990–2006. Med Sci Monit 2007; 13:318-322.
• Sharma BK, Kumari S, Varma SC, Sagar S, Singh S. Prolonged undiagnosed fever in northern India. Trop Geogr Med 1992;44:32-6.
• Konecny P, Davidson RN. Pyrexia of unknown origin in the 1990s: time to redefine. Br J Hosp Med 1996;56:21-4.
• Agmon-Levin N, Ziv-Sokolovsky N, Shull P, Sthoeger ZM. Carcinoma of colon presenting as fever of unknown origin. Am J Med Sci 2005;329:322- 6.
• Singh N, Yu VL, Wagener MM, Gayowski T. Cirrhotic fever in the 1990s: a prospective study with clinical implications. Clin Infect Dis 1997;24:1135-8.
• Zenone T. Fever of unknown origin in rheumatic diseases. South Med J 2000;93:926-9.