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Tuberculosis as a cause of recurrent fever of unknown origin
1Section of Infectious Diseases, Hospital de Galdakao, Vizcaya, Spain.
Abstract:
Recurrent fever constitutes a diagnostic challenge for clinicians, due mainly to the intermittent nature of the fever that results in incomplete investigations. We describe three patients with recurrent fever thought to be due to tuberculosis, and review the 14 previously reported cases who fulfil the criteria of recurrent fever for at least 1 month's duration. The median duration of symptoms before diagnosis was 5 months, and the duration of the febrile bouts ranged from a few hours to 1 week. The most common complaints were constitutional symptoms and abdominal pain, and most patients had significant underlying conditions. The mortality rate was 31%, and was limited to the earlier cases. Routine laboratory studies are not very helpful for the diagnosis of this condition, and chest radiographs showed some alteration in half the cases at the time of diagnosis, although in some cases represented old, healed lesions. PPD testing was positive in most cases, particularly in those without underlying conditions. Empirical antituberculous therapy should be considered in cases of recurrent fever, especially in areas of high prevalence or in patients with predisposing conditions.
Insights
Recurrent fever, often challenging to diagnose, can be a sign of tuberculosis (TB). Early consideration of empirical antituberculous therapy is recommended, especially in high-prevalence areas.
Area of Science:
- Infectious Diseases
- Clinical Medicine
- Pulmonology
Background:
- Recurrent fever presents a diagnostic dilemma due to its intermittent nature.
- Tuberculosis (TB) is a significant cause of prolonged fever, often overlooked initially.
Observation:
- This study reviews 17 cases (3 new, 14 prior) of recurrent fever attributed to TB.
- Symptoms included constitutional issues and abdominal pain, with a median diagnostic delay of 5 months.
- Underlying conditions were common, and mortality was 31% in earlier cases.
Findings:
- Routine tests and chest X-rays were often inconclusive for diagnosing recurrent fever from TB.
- Purified protein derivative (PPD) testing was positive in most patients, especially those without comorbidities.
- Febrile episodes varied in duration, from hours to a week.
Implications:
- Empirical antituberculous therapy should be considered for undiagnosed recurrent fever.
- High-risk populations include those in endemic areas or with predisposing health conditions.
- Prompt diagnosis and treatment can improve outcomes and reduce mortality associated with TB-related recurrent fever.