[ ](FUO) FUO 2005 1 2010 12 FUO 340 340 295 (86.8%) 150 (44.1%) 145 (42.7%)45 (13.2%) 186 (54.7%) 154 (45.3%) (48.4 17.2 ) Still(27.4 11.9 ) 4 202 (59.4%) 4 8 50 (14.7%) >8 88 (25.9%) FUO [ ] [ ] R441.3 [ ] A [ ] 0577-7402(2013)03-0217-05 LI Zhi 1, QI Jun-ying 2*, GUO Wei 2, GUO Hui 2 1 Department of Infectious Diseases, 161 Hospital of PLA, Wuhan 430010, China 2 Department of Infectious Diseases, Tongji Hospital of Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430030, China *Corresponding author, E-mail: jyqi@tjh.tjmu.edu.cn [Abstract] Objective To analyze the etiology, clinical characteristics and diagnostic methods of fever of unknown origin (FUO), so as to provide a reference for the diagnosis and treatment of FUE. Methods The clinical data of 340 patients with FUO admitted in Tongji Hospital from Jan. 2005 to Dec. 2010 were retrospectively analyzed. The relationship between etiology and gender, age of the patients, and course of fever were comprehensively evaluated, and the diversity of disease spectrum was also analyzed. Results Among the 340 patients analyzed, 295(86.76%) the diagnosis was definitely made. As to the etiology, 150(50.85%) were suffering from infectious diseases, 145(49.15%) non-infectious diseases, and in 45(13.24%) the etiology remained unknown till they were discharged from hospital. Among all of the patients, 186(54.71%) were male and 154(45.29%) were female. No significant difference existed in the ratio of disease distribution between male and female patients, but the incidence of connective tissue disease was significantly higher in female patients than in male patients, while the incidence of lymphoma was significantly higher in male patients than in females. As to the age distribution of the disease, 66 patients (19.41%) were younger than 20 years old, 98 patients (28.82%) were 21-40, 136(40.00%) were 41-60, and 40(11.76%) were older than 60. The mean age of patients suffering from solid tumors was the highest (48.4 17.2 years), and that of adult Still disease was youngest (27.4 11.9 years). The course of fever in 202 patients (59.41%) was shorter than 4 weeks, that of 50 patients (14.71%) was 4-8 weeks, and in 88 patients (25.88%) it was longer than 8 weeks. Febrile course was longest in patients suffering from connective tissue disease, lymphoma and tuberculosis. Conclusions Most of the patients with FUO could be definitely diagnosed prudent inquiry of history, followed by scrupulous physical examination, aided by appropriate instrumental examination, most cases of FUO could be definitely diagnosis. Among these patients, infectious diseases remain the main causes of FUO. The disease spectrum will be diverse due to different gender, age and course of fever. [Key words] fever of unknown origin; diagnosis; retrospective studies [ ] [ ] 430010 161 ( ) 430030 ( ) [ ] E-mail: jyqi@tjh.tjmu.edu.cn
2013 3 1 38 3 (fever of unknown origin FUO) 2005 1 2010 12 FUO 340 FUO 1 1.1 2005 1 2010 12 FUO 340 186 1541.21:1 39.9 16.9(13 80) 1.2 1961 Petersdorf Beeson [1] FUO3 38.3 [2] 1.3 Excel SAS 8.0 χ 2 FisherP<0.05 2 2.1 340 295 86.8% 14 78.6%(11/14) 10 (2 2 1 21 1 1 ) 3 [ (MRSA)1 1 1 ] 1 ( ) 11 ( 1) 1FUO Fig.1 Cause composition of FUO patients Infectious disease(n=150) Case Percentage(%) Non infectious disease(n=145) Case Percentage(%) Bacterial infection 82 27.8 Connective tissue disease 39 13.2 Typhoid fever 6 2.0 Adult onset still's disease 14 4.8 Tuberculosis 35 11.9 Solid tumor 26 8.8 Viruses 17 5.8 Lymphoma 34 11.5 Parasite 9 3.1 Hyperthyroidism 2 0.7 Fungus 1 0.3 Drug fever 5 1.7 Diseases of blood system 25 8.5 2.2 (P>0.05) (P<0.05) (P<0.05 2) 2.3 Still40 60 48.4 17.2 (46.0 15.2 ) Still 27.4 11.9 2.4 FUO 4 202 (59.4%) 4 8 50 (14.7%) >8 88 (25.9%) (184.9 321.6d)> (175.6 466.6d)> (102.9 194.9d)> (91.2 169.3d)> Still (71.0 106.9d)> (53.3 43.6d) Still 16.3 10.1d (14.3 7.9d) (10.4 7.1d) 2.5 3 2005 8.6% 2010 15.4% (P>0.05) 2[ (%)] Fig.2 Comparison of disease spectrum between male and female patients [case(%)] Gender Infectious disease Connective tissue disease Adult onset Still's disease Diseases of blood system Solid tumor Lymphoma Male 81(52.3) 14(9.0) 8(5.2) 11(7.1) 11(7.1) 24(15.5) Female 69(57.0) 25(20.7) (1) 6(5.0) 14(11.6) 15(12.4) 10(8.3) (1) (1)P<0.05 compared with male
3 2005 2010 FUO [ (%)] Fig.3 Characteristics of main etiological distribution from 2005 to 2010[case(%)] Cause of disease 2005 2006 2007 2008 2009 2010 Infectious disease 19(54.3) 17(60.7) 17(46.0) 29(56.9) 24(42.1) 37(47.4) Bacterial infection 11(31.4) 13(46.4) 11(29.7) 17(33.3) 13(22.8) 17(21.8) Tuberculosis 3(8.6) 3(10.7) 4(10.8) 7(13.7) 6(10.5) 12(15.4) Connective tissue disease 2(5.7) 2(7.1) 5(13.5) 5(9.8) 13(22.8) 12(15.4) Adult onset Still's disease 3(8.6) 1(3.6) 1(2.7) 3(5.9) 2(3.5) 4(5.1) Solid tumor 3(8.6) 1(3.6) 3(8.1) 4(7.8) 6(10.5) 9(11.5) Lymphoma 6(17.1) 3(10.7) 7(18.9) 5(9.8) 6(10.5) 7(9.0) Diseases of blood system 1(2.9) 3(10.7) 4(10.8) 4(7.8) 5(8.8) 8(10.3) Sum 34 27 37 50 56 77 3 FUO [3] 340 FUO 295 86.8% [4-6] FUO 44.1% [6] 27.8% 11.9% ( Still ) (18.0%) (11.5%) (8.8%) (8.5%) 14 78.6%(11/14) 71.4%(10/14) FUO1~3 71.43% Still Still 2005 2010 17.97% Still 14 6 2 2 1 1 1 26 Still [7-8] 4060 [7] Still 71 Still C (SFe) Still SFe5 StillSFe [9] Still 86.52% SFe 5 75.23% SFe (>10 ) Still 20% SFe [10] 35 60
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