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Fever of undetermined origin: not what it used to be
Abstract:
Eighty cases of fever of undetermined origin seen at Dallas VAMC from 1979 to 1985 were analyzed. Infectious etiology was the cause in one half, with equal numbers of localized infections or systemic infections. In contrast to older series, viral infections were frequently seen, but tuberculosis and malaria were less commonly noted. Solid tumors were the most frequently diagnosed non-infectious cause of fever. Fevers secondary to malignancy commonly responded to non-steroidal anti-inflammatory agents. Patterns of illness were helpful in defining certain diseases such as adult Still's disease and polymyalgia rheumatica. Diagnostic tests of value are discussed.
Insights
This study analyzed 80 fever of unknown origin cases, finding infections and solid tumors as common causes. Viral infections were frequent, unlike less common tuberculosis and malaria, with fevers responding to anti-inflammatory agents.
Area of Science:
- Internal Medicine
- Infectious Diseases
- Rheumatology
Background:
- Fever of unknown origin (FUO) presents a diagnostic challenge.
- Previous studies on FUO etiology may not reflect current trends.
Purpose of the Study:
- To analyze the causes and patterns of FUO in a specific patient cohort.
- To identify changes in FUO etiology compared to older literature.
- To evaluate the utility of diagnostic tests and treatment responses.
Main Methods:
- Retrospective analysis of 80 FUO cases at Dallas VAMC (1979-1985).
- Categorization of causes into infectious and non-infectious etiologies.
- Review of clinical presentations, diagnostic findings, and treatment outcomes.
Main Results:
- Infectious causes accounted for 50% of FUO cases, equally divided between localized and systemic infections.
- Viral infections were notably frequent, while tuberculosis and malaria were less common.
- Solid tumors were the most frequent non-infectious cause; associated fevers often responded to NSAIDs.
- Distinct illness patterns aided in diagnosing conditions like adult Still's disease and polymyalgia rheumatica.
Conclusions:
- Infectious diseases and malignancies remain significant causes of FUO.
- Trends in FUO etiology have shifted, with increased viral infections.
- Understanding specific clinical patterns and utilizing appropriate diagnostic tests are crucial for managing FUO.