Prospective evaluation of fever of unknown origin in patients infected with the human immunodeficiency virus

Abstract

The aim of this study was to determine the frequency and aetiology of fever of unknown origin (FUO) in patients infected with the human immunodeficiency virus (HIV), to assess the value of the tests used in its diagnosis, and to evaluate possible models of diagnosis for the causes found most frequently. One hundred twenty-eight (3.5%) of 3603 hospitalised HIV-positive patients evaluated from October 1992 to December 1993 had FUO, defined by established criteria. Eighty-six percent of patients with FUO had previously progressed to AIDS. The median CD4+ cell count was 46/mm3. A definite diagnosis was made in 96 (75%) of the 128 patients and a possible diagnosis in 24 (18.7%). whilst no diagnosis was made in eight cases (6.2%). Tuberculosis (48.3%), visceral leishmaniasis (16%), and infection by Mycobacterium avium complex (6.9%) were the diseases found most frequently. The most useful diagnostic tests were liver biopsy (68.9%) and bone marrow aspirate/biopsy (39.7%). It is not possible to predict clinically the cases of FUO due to tuberculosis, whilst thrombocytopaenia < 100,000 cells/mm3 alone is useful for differentiating the cases of visceral leishmaniasis, with a negative predictive value of 95.2%.

Etiology, Clinical Features and Outcome of Splenic Microabscesses in HIV-Infected Patients with Prolonged Fever

“…Since Durack and Street [20] reexamined the phenomenon of fever of unknown origin (FUO) and defined the first criteria for HIV-associated FUO, several clinical studies have been conducted evaluating this phenomenon [21][22][23][24]. In these studies, clinical, radiological or microbiological evidence of a focal condition was considered as an exclusion criterion [21][22][23][24]. Applying the criteria of Lozano et al [24], 11 patients in the present study could be considered as having FUO.…”

Diagnostic Value of Percutaneous Liver Biopsy in Fever of Unkown Origin in Patients with Human Immunodeficiency Virus Infection

“…Fever of unknown origin (FUO) has also been acknowledged as a major issue among these patients (2)(3)(4)(5). The advent of combined highly active antiretroviral therapy (HAART) has largely contributed to the declining morbidity and mortality rates among HIV-infected patients in both resource-rich and resource-constrained countries (6)(7)(8).…”

Detecting DisseminatedMycobacterium aviumComplex Infections in HIV-Positive Patients: The Usefulness of Bone Marrow Trephine Biopsy Specimens, Aspirate Cultures, and Blood Cultures

“…[7][8][9] Examination of the bone marrow aspirate and trephine biopsy specimens can reveal the presence of disseminated granulomatous disease, as well as microorganisms, including MAC, Mycobacterium tuberculosis, Cryptococcus neoformans, and Histoplasma capsulatum. l0~12 The bone marrow biopsy is a relatively high yield procedure for detection of microorganisms and is associated with a low complication rate."…”