Etiological study of fever of unknown origin in patients admitted to medicine ward of a teaching hospital of Eastern India

Abstract

Background:In a developing country, infectious disease remains the most important cause of fever, but the noncommunicable diseases, like malignancy, are fast becoming important differential diagnoses. An important clinical problem is the cases labeled as fever of unknown origin (FUO), which often evade diagnosis.Objective:The present study was undertaken to find the cause of FUO in a tertiary care hospital of eastern India.Materials and Methods:This is a prospective study of inpatients, with regard to both clinical signs and investigations.Results:The main diagnosis in the end was tuberculosis, closely followed by hematological malignancy. A substantial number of cases remained undiagnosed despite all investigations. The provisional diagnosis matched with the final in around two thirds of the cases. While for younger patients leukemia was a significant diagnosis, for older ones, extra-pulmonary tuberculosis was a main concern.Interpretation:In India, infectious disease still remains the most important cause of fever. Thus the initial investigations should always include tests for that purpose in a case of FUO.Conclusion:Geographic variations and local infection profiles should always be considered when investigating a case of FUO. However, some of the cases always elude diagnosis, although the patients may respond to empirical therapy.

Diagnostic accuracy of C-reactive protein for active pulmonary tuberculosis: a meta-analysis

“…17,21,29–31 Unlike most outpatient studies, none of the inpatient studies were designed to evaluate the diagnostic accuracy of CRP for pulmonary TB; 17,21,29–31 in general, these studies were judged to have higher and/or unclear risk of bias and greater concerns for applicability for all domains. Only two studies reported enrolling a consecutive or random sample of patients, 17,21 while the remaining studies did not provide sufficient information to determine the patient selection method.…”

“…Only two studies reported enrolling a consecutive or random sample of patients, 17,21 while the remaining studies did not provide sufficient information to determine the patient selection method. 29–31 Most studies did not enroll a representative spectrum of patients. 17,29–31 Although all studies used culture as the reference standard for TB, 17,21,29–31 none of the studies explicitly stated that researchers assessing TB status were blinded to CRP results and only one study reported the time elapsed between blood collection for CRP testing and specimen collection for TB evaluation.…”

“…29–31 Most studies did not enroll a representative spectrum of patients. 17,29–31 Although all studies used culture as the reference standard for TB, 17,21,29–31 none of the studies explicitly stated that researchers assessing TB status were blinded to CRP results and only one study reported the time elapsed between blood collection for CRP testing and specimen collection for TB evaluation. 17 Industry involvement was unknown for three studies 29–31 and acknowledged by one study.…”

“…Two studies were conducted in countries with high TB/HIV burden 17,29 and the remaining three studies were conducted in countries with low to intermediate TB burden (Table 1). 21,30,31 Overall, 185 patients (28%) had pulmonary TB, and prevalence ranged from 11 to 93%.…”

“…21,30,31 Overall, 185 patients (28%) had pulmonary TB, and prevalence ranged from 11 to 93%. Four studies included patients infected with HIV (N=287), 17,21,29,31 including two studies that restricted enrollment to HIV-infected individuals. 17,21 All studies enrolled hospitalized patients who self-reported symptoms suggestive of TB: 17,21,29–31 two studies enrolled patients with pulmonary infiltrates on chest imaging, 30,31 one study enrolled HIV-infected patients with respiratory symptoms, 21 one study enrolled HIV-infected patients with suspected smear-negative pulmonary TB, 17 and one study enrolled patients with fever of unknown origin (FUO).…”