Fever of Unknown Origin in Taiwan

Chin, Chuen; Chen, Y.-S.; Lee, S. S.-J.; Wann, Shue Ren; Lin, Hsi Hsun; Lin, Wei; Huang, Chun Kai; Tsai, Hung Chin; Kao, Chih-Hsiang; Yen, Muh Yong; Liu, Y.-C.

doi:10.1007/s15010-006-5010-2

Cited by 24 publications

(19 citation statements)

References 18 publications

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“…In developing countries, infections are the major cause of FUO [7][8][9][10][11][12][13][14] , whereas in developed countries NIID account for most cases. [15][16][17][18] In several recent studies no cause could be found in a large proportion of patients (Table 1).…”

Section: Defi Nition and Causesmentioning

confidence: 99%

Fever of unknown origin

2015

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Fever of unknown originMore than 50 years after the fi rst defi nition of fever of unknown origin (FUO), it still remains a diagnostic challenge. Evaluation starts with the identifi cation of potential diagnostic clues (PDCs), which should guide further investigations. In the absence of PDCs a standardised diagnostic protocol should be followed with PET-CT as the imaging technique of fi rst choice. Even with a standardised protocol, in a large proportion of patients from western countries the cause for FUO cannot be identifi ed. The treatment of FUO is guided by the fi nal diagnosis, but when no cause is found, antipyretic drugs can be prescribed. Corticosteroids should be avoided in the absence of a diagnosis, especially at an early stage. The prognosis of FUO is determined by the underlying cause. The majority of patients with unexplained FUO will eventually show spontaneous remission of fever. We describe the defi nition, diagnostic workup, causes and treatment of FUO. Defi nition and causesFever of unknown origin (FUO) was fi rst defi ned by Petersdorf and Beeson in 1961, who defi ned FUO as body temperature above 38.3°C (101°F) on three or more occasions and a duration of illness of at least three weeks, in which no diagnosis was made after one week of hospital admission. 1 In the following years this defi nition was modifi ed. Immunocompromised patients are now excluded, 2 as these patients have other etiologies of FUO and need a different therapeutic approach. To refl ect the increasing outpatient-based healthcare it was suggested to shorten the duration of investigation to three inpatient days or three outpatient visits. 2 However, as investigations in three outpatient visits and three inpatient days cannot be compared, different causes of FUO will be found in admitted patients. Instead of using arbitrary quantitative time criteria, a quantitative criterion of obligatory investigations was implemented in the defi nition. [3][4][5] The current defi nition of FUO is: ABSTRACT > temperature ≥38.3°C (101°F) on at least two occasions > duration of illness ≥3 weeks or multiple febrile episodes in ≥3 weeks > not immunocompromised (neutropenia for ≥1 week in the 3 months prior to the start of the fever; known HIVinfection; known hypogammaglobulinemia or use of 10 mg prednisone or equivalent for ≥2 weeks in the 3 months prior to the start of the fever) > Diagnosis uncertain despite thorough history-taking, physical examination and the following investigations: erythrocyte sedimentation rate or C-reactive protein, haemoglobin, platelet count, leukocyte count and differentiation, electrolytes, creatinine, total protein, protein electrophoresis, alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, creatine kinase, antinuclear antibodies, rheumatoid factor, microscopic urinalysis, ferritin, three blood cultures, urine culture, chest X-ray, abdominal ultrasonography and tuberculin skin test.

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Section: Defi Nition and Causesmentioning

confidence: 99%

Fever of unknown origin

2015

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“…For example, for those diagnosed with bronchopneumonia/pneumonia, no bacteriological/virological cultures were done to isolate the causative agent, and no antimicrobial sensitivity tests were done where empirical antibiotics were given instead. The diagnosis of non-infectious inflammatory / autoimmune diseases was mainly by Anti Nuclear Antibody and Rheumatoid Factor (ANARF), whereas in other studies, ANCA, Anti Ds-DNA, Anti-Ro and Anti-La were used to reach a more specific diagnosis [21]. In France [16], the diagnostic work-up is split into multiple steps.…”

Section: Discussionmentioning

confidence: 99%

“…In the third step, more expensive or invasive tests are used, such as bone marrow aspiration and/or biopsy, liver biopsy, molecular genetic tools, scintigraphy, or positron emission tomography (PET). In Taiwan [21], diagnostic work-up begins with routine hematological and biochemical and radiological investigations performed on all patients. Phase 1 diagnostic protocol is adopted in patients without potential diagnostic clues (PDCs) or with misleading clues, and a phase 2 diagnostic protocol for patients without PDCs is applied when phase 1 did not reveal any.…”

Section: Discussionmentioning

confidence: 99%

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Clinico-epidemiological profile of fever of unknown origin in an Egyptian setting: A hospital-based study (2009–2010)

Kabapy

Kotkat

Shatat

et al. 2016

J Infect Dev Ctries

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Introduction: Fever of unknown origin (FUO) is one of the most challenging diagnostic dilemmas in the field of infectious diseases and tropical medicine. Clinicians should use the frequency distribution of disorders causing FUO to guide their diagnostic approach in patients with prolonged, unexplained fevers meeting the definition of FUO. Methodology: The present study was undertaken to examine the etiologies, clinico-epidemiologic profile, and prognosis of classical FUO in patients reporting to the Alexandria Fever Hospital in Egypt. Records of 979 patients admitted to the fever hospital (from January 2009 to January 2010) and diagnosed as having FUO were examined carefully. FUO was defined as three outpatient visits or three days in the hospital without elucidation of cause of fever. Results: A total of 979 cases (57.0% males and 43.0% females), with ages ranging from 0.2 to 90 years, were investigated. The mean duration of fever before hospitalization was 31 ± 10 days. The etiology of FUO was delineated in 97% of cases, and only 3% remained undiagnosed. Diagnoses were grouped into five major categories. Infectious causes of FUO were strongly associated with better outcome (73.7% improved). Smoking, contact with animals or birds, drug addiction, and HIV seropositivity were important risk factors associated with infections. Conclusions: Infections are the most common cause of FUO, followed by collagen vascular diseases, in our region. A three-step diagnostic work-up approach is recommended to be applied in Egypt in order to improve the quality of medical service provided to FUO patients.

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“…Table 2: Comparison of some of the studies on fever of unknown origin from other parts of the world P = prospective; R = retrospective; ND = not described; AIDS = acquired immunodeficiency syndrome From the year 2000-2010 7,[16][17][18][19][20][21][22][23][24][25][26] there has been a decrease in the incidence of infections ranging from 16%-57%, this is in parallel to slight increase in the proportion of cases diagnosed to have inflammatory diseases. This change could be both due to the increasing awareness on inflammatory diseases as well as advances in nuclear scans helping in localising the active focus responsible for fever.…”

Section: Changing Trends In the Aetiologymentioning

confidence: 99%

Fever of unknown origin (FUO): Evolution of case definition, changing aetiological spectrum

Kumar¹,

Kumar²,

Rajeshwari³

et al. 2016

J Clin Sci Res

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Prolonged fever is a common problem faced by clinicians in everyday practise. Since the first description of the entity "fever of unexplained origin" by Petersdorf and Beeson in 1961, the case definition of this entity was further refined with modifications over the last 55 years. Durack and Street proposed noteworthy changes in the definition of "fever of unknown origin (FUO)". First, they divided FUO into four groups, namely, classic, nosocomial, human immunodeficiency virus (HIV) related and neutropenic FUO. They also proposed a change in the time frame from "one week hospital study" to "three outpatient visits or three days of in-hospital investigations". The more recent definition modified the temperature recording of above 38.3 o C (101 o F) on "several occasions" to "at least two occasions" and has listed the minimum essential laboratory testing required for diagnosis. The last five decades have also witnessed a change in the aetiological spectrum of FUO. Infectious diseases like tuberculosis are still common causes of FUO in India; an increase in non-infectious causes of FUO are increasingly being documented in studies form the west. Inspite of great advances in imaging and laboratory diagnostic methods a significant number of patients with FUO remained undiagnosed. Studies from other parts of the world have shown 9%-78% cases of FUO to remain undiagnosed while studies from India have shown this figure to be 0%-27.4%. Generating reliable epidemiological data regarding the aetiological spectrum of FUO will facilitate development of optimal work-up strategy to establish the aetiological diagnosis and facilitate the specific tests.

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Fever of Unknown Origin in Taiwan

Abstract: Mycobacteriosis is still the leading cause of FUO in Taiwan and it is important to identify this treatable disease from all causes of FUO. This study has showed geographical variation among the studies of FUO.

Cited by 24 publications

References 18 publications

Fever of unknown origin

Fever of unknown origin

Clinico-epidemiological profile of fever of unknown origin in an Egyptian setting: A hospital-based study (2009–2010)

Fever of unknown origin (FUO): Evolution of case definition, changing aetiological spectrum

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