Objective: To explore the etiologies and clinical characteristics of fever of unknown origin (FUO) and to provide clues for early diagnosis of FUO. Methods: The data about etiology, age, sex, clinical course, length of hospital stays and the expression levels of inflammatory factors in fever phase of 357 pediatric inpatients who were diagnosed with FUO in Children's Hospital of Fudan University from 1 January 2016 to 31 December 2020 were collected and retrospectively analyzed. Participants were grouped into infectious disease, inflammatory disease, malignancy and others and according to the classification of diseases and also grouped into those aged<1 year, 1-<3 years,3-<6 years, 6-<12 years and 12-<18 years. Comparisons between groups were performed using the Mann-Whitney U test, Kruskal-Wallis H test and χ² test. Results: Among the 357 patients (217 males and 140 females). The age of onset was 3.9 (1.3, 9.2) years and visiting age was 5.1 (2.0, 9.3) years. The time-consuming of diagnosis was 94 (66, 213) days. The hospital stay was 8 (6, 14) days. The most frequently identified cause of FUO was infectious diseases (163 cases, 45.7%), followed by non-infectious inflammatory diseases (133 cases, 37.2%), malignancy (21 cases, 5.9%) and others (40 cases, 11.2%). The patients at younger age were more likely to be attacked by malignancy, oncologic diagnoses, and others, nevertheless patients at older age were more likely to be attacked by non-infectious inflammatory diseases oppositely (9.8 (3.6, 11.5) vs. 3.0 (1.2, 7.0), 2.3 (1.0, 5.2), 0.9 (0.5, 1.8) years, U=41.30, 15.94, 37.08, all P<0.01);106 (65%) patients were male, and 57 (35%) patients were female. This result indicated that boys were more susceptible to infectious diseases (χ²=14.73, P<0.01). Analysis of inflammatory factors in serum among 103 patients, interleukin (IL)-6 level in 40 infectious diseases patients (9 (2, 38) ng/L) was significantly lower than those of 6 tumor patients (89 (64, 599) ng/L) and 57 non-infectious inflammatory diseases patients (25 (8, 78) ng/L, U=51.05, 15.70, both P<0.05), no significant difference was observed in IL-2, IL-4, IL-10, tumor necrosis factor α and interferon among the groups (all P>0.05). The patients grouped into those aged 1-<3 years and 3-<6 years were more likely to be attacked by infectious diseases (51.3% (59/115) and 57.1% (40/70)), while patients grouped into those aged 6-<12 years and 12-<18 years were more likely to be attacked by non-infectious inflammatory diseases (55.6% (65/117) and 72.4% (21/29)). Conclusions: Infectious disease is still the main cause of FUO in children and the boys are more susceptible to infectious diseases. However, the morbidity of non-infectious inflammatory diseases increases to number 1 in FUO of children over 6 years of age.
Aged ; Child ; Communicable Diseases/complications* ; Female ; Fever of Unknown Origin/etiology* ; Humans ; Length of Stay ; Male ; Neoplasms/complications* ; Retrospective Studies

Female ; Fever of Unknown Origin ; diagnosis ; etiology ; Humans ; Middle Aged ; Spinal Cord Diseases ; complications ; diagnosis

BACKGROUNDDespite the recent advances in medicine, fever of unknown origin (FUO) remains a diagnostic and therapeutic challenge even to expert physicians. To increase the knowledge of FUO, we conducted a retrospective study to investigate the causes of FUO and the change of major causes of FUO during the past 26 years.

METHODSThe clinical data were retrospectively analyzed from 997 patients with FUO hospitalized at the Peking Union Medical College Hospital (PUMCH) between January 2004 and October 2010. Furthermore, the results were compared to that reported in previous studies of FUO in PUMCH since 1985.

RESULTSOf the 997 FUO cases, definite diagnosis was eventually achieved in 797 (79.9%) patients. The most common cause of FUO was infectious diseases (479 cases, 48.0%), with tuberculosis accounting for 45.3% (217/479) of the cases of infections. One hundred and sixty-eight (16.9%) patients were diagnosed with connective tissue diseases, with Still's disease and vasculitis accounted for 31.5% (53/168) and 24.4% (41/168) of this category, respectively. Neoplasms and miscellaneous causes were found in 7.9% (79/997) and 7.1% (71/997), respectively. However, no definite diagnosis had been made in the remaining 200 (20.1%) cases until they were discharged from the hospital.

CONCLUSIONSDuring different periods, infectious diseases, especially tuberculosis, were the leading etiology of FUO and the proportion of tuberculosis had no significant difference. While the frequency of neoplasms was descending, the proportion of lymphoma in neoplasm was ascending; the frequency of undiagnosed cases was increasing, but in most FUO cases the causes can be diagnosed eventually after careful analysis of clinical data.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Communicable Diseases ; complications ; Diagnosis, Differential ; Female ; Fever of Unknown Origin ; etiology ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tuberculosis ; complications ; Young Adult

Aged, 80 and over ; Aspergillus ; isolation & purification ; Fever of Unknown Origin ; etiology ; Humans ; Invasive Pulmonary Aspergillosis ; complications ; microbiology ; pathology ; Length of Stay ; Long-Term Care ; Lung Diseases, Interstitial ; complications ; pathology ; Male ; Pulmonary Alveoli ; pathology ; Respiratory Distress Syndrome, Adult ; complications ; pathology

OBJECTIVETo investigate the etiology and clinical features of fever of unknown origin (FUO).

METHODSThe clinical data including etiology, diagnostic approaches, and clinical features were retrospectively analyzed in 816 patients with FUO who were presented in our department from January 2000 to January 2009.

RESULTSOf these 816 FUO cases, 766 (93.9%) were confirmed to be with infective diseases(40.4%, n=330), connective tissue diseases (34.4%, n=281), malignant tumors (10.9%, n=89), other known diseases (8.1%, n=66), and unknown diseases (6.1%, n=50). The most common infective disease was tuberculosis (49.7%, 164/330), the most common connective tissue disease was adult-onset Stills disease (AOSD)(55.2%, 155/281), the most common malignant tumor was lymphoma(56.2%, 50/89), and the most common "other known disease" was Crohns disease(22.7%, 15/66). All lung cancer cases had obstructive pneumonia. Significantly more elderly patients suffered from infective diseases (49.4% vs.32.0%) and malignant tumor (15.6% vs. 6.4%) compared with the non-elderly (both P=0.0000), while the proportion of connective tissue diseases was significantly less than that of the non-elderly (17.9% vs. 50.1%, P=0.0000).

CONCLUSIONSMost FUO can be confirmed after careful examinations and analysis. The main cause of FUO is infective diseases, especially tuberculosis in the elderly. The connective tissue diseases and malignant tumors are also important causes.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Connective Tissue Diseases ; complications ; Female ; Fever of Unknown Origin ; diagnosis ; etiology ; Humans ; Male ; Middle Aged ; Neoplasms ; complications ; Retrospective Studies ; Tuberculosis ; complications ; Young Adult

PURPOSE: Procalcitonin (PCT) is a current, frequently used marker for severe bacterial infection. The aim of this study was to assess the ability of PCT levels to differentiate bacteremic from nonbacteremic patients with fever. We assessed whether PCT level could be used to accurately rule out a diagnosis of bacteremia. MATERIALS AND METHODS: Serum samples and blood culture were obtained from patients with fever between August 2008 and April 2009. PCT was analyzed using a VIDAS(R) B.R.A.H.M.S PCT assay. We reviewed the final diagnosis and patient histories, including clinical presentation and antibiotic treatment. RESULTS: A total of 300 patients with fevers were enrolled in this study: 58 with bacteremia (positive blood culture) (group I); 137 with local infection (group II); 90 with other diseases (group III); and 15 with fevers of unknown origin (group IV). PCT levels were significantly higher in patients with bacteremia than in those with non-bacteremia (11.9 +/- 25.1 and 2.5 +/- 14.7 ng/mL, respectively, p < 0.001). The sensitivity and specificity were 74.2% and 70.1%, respectively, at a cut-off value of 0.5 ng/mL. A serum PCT level of < 0.4 ng/mL accurately rules out diagnosis of bacteremia. CONCLUSION: In febrile patients, elevated PCT may help predict bacteremia; furthermore, low PCT levels were helpful for ruling out bacteremia as a diagnosis. Therefore, PCT assessment could help physicians limit the number of prescriptions for antibiotics.
Bacteremia/blood/*diagnosis ; Biological Markers/blood ; C-Reactive Protein/analysis ; Calcitonin/*blood ; Early Diagnosis ; Female ; Fever/blood/*diagnosis/etiology ; Fever of Unknown Origin/blood/diagnosis/microbiology ; Humans ; Male ; Middle Aged ; Protein Precursors/*blood ; Sensitivity and Specificity ; Young Adult

Adult ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; CD56 Antigen ; metabolism ; Cyclophosphamide ; therapeutic use ; Doxorubicin ; therapeutic use ; Fever of Unknown Origin ; etiology ; Humans ; Lymphoma, Extranodal NK-T-Cell ; complications ; metabolism ; pathology ; therapy ; Male ; Prednisone ; therapeutic use ; Splenectomy ; Splenic Neoplasms ; complications ; metabolism ; pathology ; therapy ; Vincristine ; therapeutic use ; Young Adult

OBJECTIVETo evaluate the application of (18)F-FDG PET/CT in diagnosis of classic fever of unknown origin.

METHODSA total of 27 consecutive patients with classic fever of unknown origin (FUO) (19 men, 8 women; aged 24-82 y) underwent (18)F-FDG PET/CT scans. The images were interpreted by visual inspection and semiquantitative analysis(standardized uptake value, SUV). Final diagnosis was based on histopathology or clinical follow-up.

RESULTSThe cause of FUO was confirmed by followed investigations in 21 of 27 cases after PET/CT scan, including 10 cases of infection, 4 of noninfectious inflammation, 4 of malignancies and 3 of miscellaneous disorders; and remaining 6 cases were still confirmed FUO. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 100.0 %, 83.3%, 83.3%, 100.0% and 96.3%, respectively.

CONCLUSIONFor patients with fever of unknown origin, (18)F-FDG-PET/CT can be a sensitive, reliable imaging modality. It is suggested that (18)F-FDG-PET/CT should be considered earlier in detecting the causes of FUO, which is difficultly diagnosed by conventional modalities.

Adult ; Aged ; Aged, 80 and over ; Diagnosis, Differential ; Female ; Fever of Unknown Origin ; diagnosis ; diagnostic imaging ; etiology ; Fluorodeoxyglucose F18 ; Humans ; Male ; Middle Aged ; Positron-Emission Tomography ; methods ; Radiopharmaceuticals ; Tomography, X-Ray Computed ; methods ; Young Adult

Adult-onset Still's disease (AOSD) is an inflammatory disease that presents with a variety of clinical symptoms. Pulmonary involvement is well-known in AOSD and is seen in up to 53% of AOSD cases, with the most common pulmonary diseases being pleural effusion and transient pulmonary infiltrates. We present the first case of chronic AOSD complicated with diffuse alveolar hemorrhage during the acute flare of the disease.
Adult ; Ankylosis/diagnosis ; Anti-Inflammatory Agents/administration & dosage ; Diagnosis, Differential ; Female ; Fever of Unknown Origin/diagnosis ; Hemorrhage/*diagnosis/drug therapy/etiology ; Humans ; Lung Diseases/*diagnosis/drug therapy/etiology ; Methylprednisolone/administration & dosage ; *Pulmonary Alveoli ; Still's Disease, Adult-Onset/complications/*diagnosis/drug therapy/radiography ; Tomography, X-Ray Computed

Gastric inflammatory myofibroblastic tumor (IMT) is an extremely rare lesion with mimicking malignant features and accompanied with various clinical manifestations. Here we present a 2-yr-old boy who had a gastric IMT with a huge extragastric mass, which closely resembled a neuroblastoma on imaging studies. He experienced intermittent fever and poor appetite for 6 weeks. Fever remained up to 38degrees C even on the operation day. He underwent partial gastrectomy and distal pancreatectomy with splenectomy including the tumor. The preoperative fever disappeared and did not recur in the postoperative course.
Child, Preschool ; Fever of Unknown Origin/*etiology ; Granuloma, Plasma Cell/*complications/*diagnosis/surgery ; Humans ; Male ; Stomach Diseases/*complications/*diagnosis/surgery