Adrien Robine1, Arnaud Hot2, Delphine Maucort-Boulch3, Jean Iwaz4, Christiane Broussolle1, Pascal Sève5. 1. Hospices civils de Lyon, hôpital de la Croix-Rousse, department of internal medicine, 69004, Lyon, France; Université de Lyon, 69000 Lyon, France. 2. Université de Lyon, 69000 Lyon, France; Hospices civils de Lyon, hôpital Edouard-Herriot, department of internal medicine, 69003 Lyon, France. 3. Université de Lyon, 69000 Lyon, France; Hospices civils de Lyon, hôpital Lyon-Sud, department of biostatistics, 69310 Pierre-Bénite, France. 4. Hospices civils de Lyon, hôpital Lyon-Sud, department of biostatistics, 69310 Pierre-Bénite, France. 5. Hospices civils de Lyon, hôpital de la Croix-Rousse, department of internal medicine, 69004, Lyon, France; Université de Lyon, 69000 Lyon, France. Electronic address: pascal.seve@chu-lyon.fr.
Abstract
PURPOSE: Despite recent diagnostic advances, a fever of unknown origin (FUO) remains a clinical challenge. METHODS: This study reports the clinical courses and outcomes of 103 cases of FUO and evaluates the places of (18)F-Fluorodeoxyglucose positrons emission tomography ((18)FDG-PET) and molecular biology in the diagnostic approach. RESULTS: This retrospective study was carried out from 2002 to 2012 in two departments of internal medicine. The diagnosis of FUO was based on the updated criteria of Durack and Street. It included 54 men and 49 women (mean age: 57 years) in 52 of whom the final diagnosis could not be established. Among the 51 patients with final diagnosis, non-infectious inflammatory disorders were the most prevalent (61%). The other diagnoses were infectious diseases (23.5%), miscellaneous causes (10%) and malignancies (6%). (18)FDG-PET was performed in 48 patients and was contributory in 10. Molecular biology techniques were performed in 28 patients and were contributory in only one case: detection of a cytomegalovirus infection by polymerase-chain-reaction assay. At study closure, eleven patients had died, of whom five died from the disease that caused the FUO. Only two deaths among the 52 patients without diagnosis could be attributed to the feverish illness. CONCLUSION: As observed in the most recent case series, the rate of undiagnosed patients is increasing. The prognosis was good for undiagnosed FUO. Here, the yield of (18)FDG-PET was 21% but that of molecular biology negligible. The recourse to molecular biology seems useless unless directed by a high degree of clinical suspicion.
PURPOSE: Despite recent diagnostic advances, a fever of unknown origin (FUO) remains a clinical challenge. METHODS: This study reports the clinical courses and outcomes of 103 cases of FUO and evaluates the places of (18)F-Fluorodeoxyglucose positrons emission tomography ((18)FDG-PET) and molecular biology in the diagnostic approach. RESULTS: This retrospective study was carried out from 2002 to 2012 in two departments of internal medicine. The diagnosis of FUO was based on the updated criteria of Durack and Street. It included 54 men and 49 women (mean age: 57 years) in 52 of whom the final diagnosis could not be established. Among the 51 patients with final diagnosis, non-infectious inflammatory disorders were the most prevalent (61%). The other diagnoses were infectious diseases (23.5%), miscellaneous causes (10%) and malignancies (6%). (18)FDG-PET was performed in 48 patients and was contributory in 10. Molecular biology techniques were performed in 28 patients and were contributory in only one case: detection of a cytomegalovirus infection by polymerase-chain-reaction assay. At study closure, eleven patients had died, of whom five died from the disease that caused the FUO. Only two deaths among the 52 patients without diagnosis could be attributed to the feverish illness. CONCLUSION: As observed in the most recent case series, the rate of undiagnosed patients is increasing. The prognosis was good for undiagnosed FUO. Here, the yield of (18)FDG-PET was 21% but that of molecular biology negligible. The recourse to molecular biology seems useless unless directed by a high degree of clinical suspicion.
Authors: William F Wright; Gayane Yenokyan; Patricia J Simner; Karen C Carroll; Paul G Auwaerter Journal: Open Forum Infect Dis Date: 2022-04-09 Impact factor: 4.423
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